By Pierre Hoffmeyer, EFORT Vice President.
In January 2009, the New England Journal of Medicine published a special article describing a study taking place in eight hospitals in eight different cities, spanning the five continents, and representing a variety of socio-economic circumstances.
1. All the complications occurring within 30 days of surgery in these hospitals were monitored. A three-month observation period established a baseline. Simple, safety-oriented guidelines published in 2008 by the World Health Organization (WHO) to ensure the safety of surgical patients worldwide were then introduced. This was followed by a second observation period.
2. The guidelines targeted operating theatre personnel and involved systematic compliance with checklists at “sign-in”, “time-out” and “sign-out” times. In essence, this simply meant that patient identity, the site of surgery and type of procedure were clearly and unequivocally identified by all members of the operating team, be they doctors, nurses or ancillary staff. The “time-out” procedure ensured clearly identified patients, procedures and surgery sites by all team members just before skin incision.
Interestingly, the report states that adherence to the measures reduced inpatient complications overall at 30 days from 11.0% to 7.0% and furthermore reduced mortality from 1.5% to 0.7%. Journalists worldwide picked up on this information and relayed it to the global media, thereby heightening public awareness of the surgical safety issue.
Avoiding surgery at the wrong site by the surgeon initialling the correct site with a skin marker pen prior to the operation should be enforced in all surgical departments, and especially in orthopaedic practice, where surgery at the wrong site can have dire consequences for the patients and for surgical careers.
3. Global campaigns involving patient safety such as “Clean care is safe care” must be promoted actively and hand washing before and after any patient contact must be made mandatory.
4. Informed care is certainly a good premise for the best care and, here again, the orthopaedic surgeon must strive to provide appropriate and satisfactory information to their patient.
Patient safety should be our primary goal. Without it no surgical operation, no matter how sophisticated the procedure or how deft the surgeon, can succeed. Many national societies, hospitals and individual surgeons use all or some of the above procedures and measures. The orthopaedic community must now come up with a unified concept for implementing these measures with all our patients throughout Europe. For too long, the initiative for preventive measures involving patient safety has been taken by persons and organisations outside of surgery. Orthopaedic surgeons must engage pro-actively in promoting all aspects of surgical safety.
EFORT encourages and endorses all initiatives and efforts in this direction.
Notes:
1) Haynes AB, Weiser TG, Berry WR, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med 2009;360:491-9.
2) World Alliance for Patient Safety. WHO guidelines for safe surgery. Geneva: World Health Organization, 2008.
3) AAOS web site: http://www5.aaos.org/wrong/setup.cfm
4) Pittet D, Dharan S. Alcohol-based rubs for hand antisepsis. Lancet Infect Dis. 2008 Oct;8(10):585-6.
