ACOG Releases Guidance on Surgical Errors

Preventing surgical errors requires more patient involvement and particular care by providers in creating checklists, systems, and routines that reduce the likelihood of surgical errors, according to the American College of Obstetricians and Gynecologists' guidance on surgical errors.

"Using standard checklists, systems, and routines may sound to some like cook-book medicine, but they have been proven to greatly reduce surgery errors," said Richard Waldman, MD, ACOG's president. "Airplane pilots routinely use checklists to reduce risks and improve safety—why shouldn't physicians?"

The ACOG said it supports the Joint Commission's "three-part universal protocol" as a useful tool for healthcare teams to prevent surgical errors. The first protocol calls for the healthcare team to ensure that each patient's relevant documents and all of the surgical equipment are available, correctly identified, and reviewed before surgery.

The second protocol calls for marking the incision or insertion site of the surgery. And, the third protocol component calls for  a "time out" before the surgery begins so the healthcare team can confirm the identity of patient and the surgical site.

Beepers, radios, telephone calls, and other "potential non- essential activities and distractions in the surgical environment should be kept to a minimum, if allowed at all, especially during critical stages of the operation," the guidance said.

Just as pilots maintain "sterile cockpits," a Federal Aviation Administration regulation requiring pilots to refrain from nonessential activities during critical parts of a flight, all members of the operating room team also should postpone nonessential conversation until surgery is finished, ACOG added.

In addition, "The presence of people in the operating room who are observing but aren't involved in the surgery should be evaluated for the value to the observer and balanced with the need to minimize distractions," said Patrice Weiss, MD, chair of the College's Committee on Patient Safety and Quality Improvement.

Another tool to enhance patient safety, ACOG said, is a checklist published by the World Health Organization (WHO). The checklist allows surgical teams to review various items and procedures before they administer anesthesia, before they make the first incision, and again before the patient is wheeled out of the operating room.

ACOG's revised patient safety recommendations should apply not only to hospitals, but also to surgeries performed in physicians' offices, freestanding surgical facilities, and surgicenters, Weiss added.