Patient safety in the operating room
- Bradford D Winters, MD, PhD
Bradford D Winters, MD, PhD
- Associate Professor of Anesthesiology & Critical Care Medicine, Neurology and Surgery
- The Johns Hopkins University School of Medicine
- Peter J Pronovost, MD, PhD
Peter J Pronovost, MD, PhD
- Professor, Departments of Anesthesiology/Critical Care Medicine and Surgery
- The Johns Hopkins University School of Medicine
- Ayse P Gurses, PhD
Ayse P Gurses, PhD
- Assistant Professor, Department of Anesthesiology and Critical Care Medicine
- The Johns Hopkins School of Medicine
Surgical and anesthetic safety has improved significantly in the last few decades. Examples of important safety advances include improved surgical techniques, technology for patient monitoring such as pulse oximetry to prevent hypoxemia, and fail-safe systems such as pin-indexing systems for gas cylinders and lines to prevent delivery of hypoxic gas mixtures. Teamwork between anesthesiologists, surgeons, and nurses also improves operating room safety. However, the operating room (OR) environment continues to have significant safety risks for patients as well as the health care providers who work there.
This topic focuses on the science of safety principles and efforts to improve safety in the OR. Related quality and safety topics that address the details of informed consent, perioperative medication management, and hospital discharge are discussed separately. (See "Informed procedural consent" and "Perioperative medication management" and "Hospital discharge and readmission".)
SCIENCE OF SAFETY TOOLS
The goal of applying scientific principles to health care practice is to reduce adverse events and improve patient safety.
Systems Engineering Initiative for Patient Safety (SEIPS) — One model of work system design for patient safety is the Systems Engineering Initiative for Patient Safety (SEIPS) [1,2]. This model is anchored in the discipline of human factors engineering and describes the five major components of a health care system:
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- SCIENCE OF SAFETY TOOLS
- Systems Engineering Initiative for Patient Safety (SEIPS)
- Safe system design
- - Standardization
- - Checklists
- - Learning from errors
- Comprehensive unit-based safety program (CUSP)
- - Education
- - Identify hazards
- - Administrative support
- - Regular meetings
- - Implementation
- INFORMED SURGICAL CONSENT
- CHECKLISTS AND BRIEFINGS
- CORRECT PATIENT, SITE, AND PROCEDURE
- INFECTION CONTROL
- Surgical site infection
- Central line infection
- NEEDLESTICK INJURIES
- PROTECTING PATIENTS FROM INJURY IN THE OPERATING ROOM
- Proper positioning
- Electrical injury
- Operating room fire
- Radiation injury
- CONNECTION ERRORS
- POSTOPERATIVE DEBRIEFING
- SUMMARY AND RECOMMENDATIONS