Published by: Susan ruce@osumc.edu - Moffatt Bruce on 3/8/2011 9:28:21 AM
When asked, “What is patient safety?” the common answer is “It is how the doctor must engage and take care of patients.” Engagement of the entire healthcare team is one of the most challenging aspects of providing safe patient care. The difficulty can be typified during a routine day in the operating theatre. How many times do we start a case and have to ask once, twice or three times if the antibiotic has been give? Later in the operation, the resident may be daydreaming whilst holding a retractor and the team may be engaged in conversations about their next holiday. The environment could very easily be viewed as chaotic. One must ask why, despite a multitude of policies and procedures, do we have such a lack of engagement?
However, rather than ask why, it is likely more constructive to define ways in which to ensure team and patient engagement. Methods for engagement can include team training and simulation training. Firstly, teams that train together will likely work better together and ultimately serve the patient. The reality of standardized service-based teams in the operating theatre is the ideal, but does not take into account human factors necessitating absences. As such, hardwired tools including “Time Out,” counting checklists and debriefings are necessary and serve as tools that ensure that every team member is engaged and a safe operation can prevail. Engaging the patient in the pre-operative verification process and marking of the site is instrumental for ensuring the correct patient and procedure.
Simulation training is another method with which to ensure team engagement. When an adverse event occurs and patient safety has been compromised, a culture of fairness and accountability must be maintained. Having the team members involved in the adverse event come together and use simulation to recreate the event provides the ability to identify root causes and opportunities to improve patient care. Whilst somewhat initially daunting, simulation training for adverse events has the potential to prevent future events as well as serve as a psychological reprieve for the healthcare team involved. With these methods to engage the healthcare team when next asked “What is patient safety?” the answer will be “It is how I WILL take care of patients every day.”
Susan Moffatt-Bruce, MD, PhD
Chief Quality and Patient Safety Officer, Assistant Professor of Surgery
The Ohio State University Medical Center