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Making surgery safer
[ by Niall Hunter, Editor www.irishhealth.com]
Surgery is a major component of hospital care and is often carried out in a pressurised, crowded and fast-moving environment.
However, it is a component of healthcare that is not without risk.
While there have been huge advances in surgical care in recent years and the overall quality of surgery in Ireland is regarded as high, things do occasionally go wrong.
There can be complications, procedural errors and avoidable infection.
The health authorities, when adverse events take place, often seek to reassure the public that these events are relatively rare, and that the standards of care are generally high.
This, while undoubtedly true, does not always assuage public concerns.
The public, while realising that adverse events are relatively rare, is often concerned that the incidence of errors taking place is too high and that the proper systems are not in place to ensure they are kept to a minimum.
In order to ensure patient safety you also need to ensure that those carrying out the surgery are following set guidelines and know everything they need to know about the procedure involved and the patient.
These may seem fairly basic rules, but in the hot-house atmosphere of busy modern hospitals, risk minimisation can sometimes fall by the wayside.
Much of the recent public debate on adverse healthcare incidents have focused not only on why specific incidents happened, but on whether the structures are in place to minimise the risk of these incidents happening.
Recently, the Health Information and Quality Authority (HIQA) launched the World Health Organisation's (WHO) Second Global Patient Safety Challenge- 'Safe Surgery Saves Lives'.
The initiative, according to HIQA, plans to introduce a surgical safety checklist to ensure that the entire surgical team has a common understanding of the procedure and risk involved and a thorough knowledge of the patient prior to any procedure taking place.
HIQA says these guidelines can be compared to pre-and post-flight checklists on commercial airlines, which have been used by pilots throughout the airline industry for many years.
HIQA points out that the recent and rapid development of surgery has hasd a major positive impact on the health of the population.
However, surgery is often delivered in pressurised, crowded and fast-moving environments involving a vast array of technologies.
An estimated 230 million operations are performed around the world each year. There are almost twice as many operations as child deliveries, and at far higher risk than childbirth.
Major complication rates from surgery worldwide range from 3-16% and death rates from 0.2-10% depending on the setting, translating into at least 7 million disabling complications and one million deaths each year.
Half of the complications and cases of death can be avoided, according to HIQA, in both the developed and developing world, if certain basic standards of care are followed.
Organisations representing health professionals and patients in Ireland, as well as a number of major hospitals, recently endorsed the WHO document and the endorsements were formally presented to the WHO at the official launch in Washington DC last week.
Dr Tracey Cooper, Chief Executive of the Health Information and Quality Authority, said this initiative puts patient safety at the forefront of the surgical process. She said it could only lead to the surgical experience for patients being even safer for the future.
Sheila O'Connor of the Patient Focus group said the initiative was very welcome.
"This initiative will have a significant impact on attitude and culture, thereby imprpving patient safety from the outset."
The objective of the initiative is to ensure that no patient will have an operation anywhere in the world without the new safety checklist being used.
The checklist includes precautions such as:
*Confirming the identity of the patient.
*Marking the site on the body for the operation.
*Checking for possible allergies.
*Checking for aspiration/airway risk.
*Surgeon, anaesthetist and nurse to verbally confirm the patient, site and procedure involved.
*Review anticipated critical events.
*Antibiotic protection given where applicable.
*Has sterility been confirmed?
The guidelines state that after the procedure is over, the surgeon, anaesthetist and nurse should review the key concerns for recovery and management of the patient.
|anonymous Posted: 12/07/2008 17:04|
|As long as surgery is carried out in centralised hospital situations, where the proper resources have not been given to that hospital to cope with extra workload, we will have errors and adverse events. It is also factual that the outcomes for such events in major hospitals are poorer. Surgeons doing the same procedure too often, especially when that is not a major operation, become complacent and make more mistakes.|
|sancon Posted: 12/07/2008 18:55|
|I welcome the WHO guidelines but cannot see them having an impact. As checklists are already in place in most theatres things do go wrong. Often leaving a patient with a complication that has a lifetime impact on them and the surgeon walks away. Going down the legal route is often not possible for the patient due to the cost. This was my experience a few years ago and I live with the surgeons mistake today and for the rest of my life|
|Anonymous Posted: 14/07/2008 11:13|
|I cannot understand why morbidity and mortality conferences are not held in Irish hospitals as they are in the U.S.|
|Anonymous Posted: 14/07/2008 14:20|
|I was admitted last year for minor key hole surgery, one of the port hole incisions nicked an artery which was not noticed during the operation. Consequences for me was emergency open surgery and 6 units of blood. I was left with a large unsighlty scar runnnig down the left hand side of my abdoman and nerve pain. To this day I have not seen the Consultant since the day of the operation even though I am still attending his outpatient's clinic. I feel it is a case of doctor's make mistakes, it is covered up or made light of and no one apologies or admits their mistake. More guidelines don't improve on human error.|
|anonymous Posted: 14/07/2008 17:17|
|I had a piece of equipment left inside me after surgery in a major hospital. I was discharged but began to pass blood copiously and was rushed back in great pain. The journey was three hours of hell. I was operated on but was never officially informed of the problem even though a nurse showed me an x-ray pointing out the offending piece which was removed.|
|CATHY Posted: 21/07/2008 23:10|
|Mistakes, misdiagnosis , misinformation,, mismanagement, all occur every day in every hospitals. It will be on the rise with the new policy of cost cutting, money saving , non employment of frontline staff|
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