The OR can be a risky place. Patients entrust their lives to surgical teams, and surgical teams need to be careful that their duty to care for others won’t affect their own health. Great strides have been made in an attempt to lower risks in the OR, and some of the most impressive are described here.
The Sterile Cockpit Concept
In aviation, there’s a protocol known as sterile cockpit, where flight crew members communicate only the necessary information to each other during takeoff, landing and other flight operations below 10,000 feet. The same concept can be used in the OR, according to the Pennsylvania Patient Safety Advisory.
The critical moments where sterile cockpit is to be applied should first be defined. This will depend on several factors, such as the following:
- The specific tasks to be performed by each team member
- The cognitive workload required from the same
- The type of procedure
The sterile cockpit aims to help team members focus their attention to the right things, at the right time.
Stricter Rules on Usage of Mobile Devices
Mobile devices have become indispensable in the OR because they allow the staff to perform time-sensitive tasks like documentation. Unfortunately, these devices have also become a source of distraction that significantly affects surgeons’ quality of work and compromises patients’ lives.
To prevent these, doctors interviewed in an AAOS article offer a number of suggestions. First, as suggested in a position paper by the American College of Surgeons, mobile devices should not be brought into the OR unless absolutely necessary. If these devices are somehow critical for the smooth performance of the operation, they must be kept in silent mode.
If a staff member needs to take a call, that person should ask “Where did we stop? Where are we starting?” the way flight crew members do in cockpits.
A checklist might seem like an overly simple, and even unnecessary, tool. But if research by the UK’s National Patient Safety Agency is anything to go by, it can cut surgery-related death by as much as 40 percent.
A checklist is more than a set of OR guidelines. It also:
- Brings focus back to the task at hand when the team members are distracted
- Decreases the chances of critical errors in high-pressure situations
- Provides team members a means to assess where they are – and where they should be – during a difficult and time-consuming operation
Improvements in Safety Equipment
Of course, the safety of the operating team should be taken into consideration. They should be protected against OR hazards such as surgical smoke exposure, and be equipped with the most cutting-edge safety tools.
Surgeons can also improve their accuracy, and minimize risks to the patient, by employing the latest technology. For example, robots are being used for hip replacement surgeries, and computer-assisted surgery (CAS) gives surgeons a non-invasive means to visualize a patient’s anatomy. As these technologies improve, so will the rates at which patients survive grueling operations.
Improvements in Staff Efficiency
Fatigue is a common problem plaguing OR workers. The stressful environment of a surgical operation can take its toll on the team members. After all, they can only do so much to stretch their human limitations. When this problem isn’t addressed, OR workers become more prone to mistakes, such as operating on the wrong side, or forgetting to remove equipment lodged inside a patient.
Hospitals have implemented various strategies to keep fatigue at bay. The Birmingham University Hospital uses the following approaches:
- Enforce block time release policies
- Use travelling nurses to make up for the manpower shortage
- Provide extra incentives for employees willing to work overtime
Integrated Operating Rooms
Before the advent of integrated operating rooms (I-ORs), surgeons had to make do with carefully arranged equipment around the operating table, using it as needed, and taking care not to trip over or damage it.
With I-ORs in place, surgeons only need to glance up and check a monitor, which displays a clearer view of the patient’s anatomy. Also, surgeons-in-training can keep their distance from the table, watch the procedure on the monitors and learn their trade with as little risk as possible.
Even if a team is technically proficient, it’s possible for them to experience problems in the OR if they don’t have soft skills. The Pennsylvania Patient Safety Advisory suggests that surgical teams engage in preoperative briefings, teamwork training, leadership training and risk-reduction training.
There’s still much room for improvement in terms of OR safety. It’s one thing to create these rules and tools, and another to enforce and use them. Hopefully, the latter will be the case in the majority of hospitals, so we’ll see better statistics concerning surgical operations in the future.