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Patient safety should be the underlying theme of all treatment, including diagnostic programs
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When patients enter the hospital to undergo examinations and treatment, I think many patients never consider they may have a negative outcome in the process. However, surgical site infection, wrong site surgery and intraoperative complications remain major issues for orthopaedic surgeons and patients. Therefore, every effort should be made to make orthopaedic and trauma treatment safe for patients.
Patient safety is both a huge and broad topic. In some respects, it applies to every aspect of our daily practices. To focus more on patient safety, this is one open-ended and initial question that orthopaedic surgeons should ask themselves more often: Is surgery the treatment needed for this patient or are other nonsurgical procedures acceptable and safer for this patient?
Use checklists
In our profession, we often say the first “cut” is always the most important one because once it is done it removes nearly every fallback option. For years, my orthopaedic colleagues have commented on the concept that surgery is a treatment option, and possibly the main consideration, only because we are orthopaedic surgeons. However, we should remember that surgery is not necessarily the treatment a specific patient needs.
Checklists are important tools to make sure we have addressed the right patient, correct site and that the surgeon who planned to carry out the procedure is fully ready to do so. Also, a checklist helps ensure all the needed prophylactic medications and therapies are given and we have all the planned instruments and implants ready. When we perform the same procedure daily, we may get the comfortable feeling that every aspect of the procedure is always lined up correctly beforehand and each step will be carried out as planned. However, this is a dangerous feeling because when we assume everything is in place and we do not use a checklist, then on any given day it may not occur to us that an instrument is missing or a needed step has not been completed.
Therefore, checklists documents should be used by the entire team. They ensure the team members are in agreement on the current steps and on the next steps that need to be performed.
After checklists, another key aspect of patient safety is the concept that we should treat our patients according to the best available evidence. This also means we should select procedures and implants proven for the condition or disease.
Needed experience
Another part of patient safety is the surgeon must recognize when he or she does not have the experience to start the treatment or surgery. They must then take the initiative to hand over the case in question to a more experienced colleague. We know how difficult it is to define and measure experience. It has little to do with the surgeon’s age, the number of procedures he or she has completed or the outcomes of the procedures over time. By all accounts, patient safety is such an individualized practice. We must be aware of those situations when we do not have the needed experience to start the planned surgery and decide when it is best to not proceed with a given surgery. However, such a decision can be difficult to make on your own. Ultimately, the chairman of the hospital’s orthopaedic department could and should be the one to discuss and help us decide whether or not we have the knowledge and experience to undertake a given surgical procedure. Taking this action is another critical aspect that promotes patient safety.
Patient safety has been selected as the theme for the upcoming EFORT Congress — a combined program in partnership with the British Orthopaedic Association being held June 4-6 in London. A symposium has been organized at the Congress that will review the hot topics related to patient safety. Other lectures and sessions at this year’s Congress have also adopted patient safety as their theme. I encourage you to attend some of these sessions, so patient safety becomes the underlying theme of all your treatments and surgeries.
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen has no relevant financial disclosures.