WASHINGTON – Starting July 1, operating rooms are supposed to be a little safer: Surgical teams must take new steps to prevent operating on the wrong body part or wrong patient.
Among the requirements: Much as airline pilots go through a safety checklist before takeoff, surgeons and nurses must take what’s being called a “time-out” before cutting. It’s to double-check that the right patient is on the table, if he’s really to lose a kidney and not a gallbladder – and if so, on which side.
Hospital regulators hope the new rules will finally put an end to growing reports of mix-ups in the operating room.
“These should never happen,” said Dr. Dennis O’Leary, who heads the Joint Commission on Accreditation of Healthcare Organizations. The agency can revoke the accreditation of hospitals or other surgical sites that don’t comply with the new safety steps.
The mixups are thought to be most frequent in orthopedic surgery. In one infamous 1995 case, a doctor amputated one man’s wrong foot.
Reports range from removing the wrong organ to drilling into the wrong side of a patient’s skull to a recent case where the wrong patient was given a heart catheterization.
No one knows exactly how many such wrong surgeries occur, because the commission receives only voluntary reports. Still, despite issuing two warnings to hospitals and surgical centers in recent years, the regulatory agency knows of 275 cases since 1999.
Consider the rushed pace of many operating rooms, where it’s easy to wheel in the wrong patient from a queue of waiting stretchers, or to position X-rays backward as bustling workers ready dozens of high-tech gadgets.
The regulatory agency is betting that if surgical teams have a mandatory system of double-checks, they can catch mixups before a patient is harmed. Among the rules:
* The surgeon must literally sign the incision site, while the patient is awake and cooperating if possible, with a marker that won’t wash off in the operating room.
Some doctors, and patients themselves, already do that voluntarily, but regulators found a confusing hodgepodge of styles. An “X” can mean “operate here” or “not here,” and writing out “not this knee” backfires if the “not” gets smudged. So, don’t place any mark on a non-operative site, the new rules stress. Avoid “X” in favor of doctor initials or some other mark used hospitalwide.
* The entire operating team must stop all other work just before surgery begins and go through a checklist to ensure the correct patient is on the table, and that everyone – surgeons, nurses, anesthesiologists, technicians – agrees what procedure is being done, on what body part.
“My rule was you do not hand a knife to any surgeon until everything’s cleared up,” said Tom McLaren, surgical services administrator at Florida’s Tallahassee Memorial Healthcare.
That rule averted one disaster at his previous hospital, McLaren recalled: A surgeon was ready to slice into a right kidney while a nurse argued for the left one. Technicians pulled back the scalpels as the frustrated doctor pointed to the posted X-ray – which a radiologist later noticed was placed backward.
O’Leary also has some consumer advice: Speak up if you’re about to be anesthetized without seeing signs that the surgical team has double-checked your identity and your surgical site.
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