Critical Roles of Orthopaedic Surgeon Leadership in Healthcare Systems to Improve Orthopaedic Surgical Patient Safety
- First Online:
- 551 Downloads
The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited.
We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems.
We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE® database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles.
Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care.
Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.
- 1.American Academy of Orthopaedic Surgeons. Surgical Safety Survey. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011.Google Scholar
- 10.Crepeau AE, McKinney BI, Fox-Ryvicker M, Castelli J, Penna J, Wang ED. Prospective evaluation of patient comprehension of informed consent. J Bone Joint Surg Am. 2011;93:e114(1–7).Google Scholar
- 11.de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA; SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010;363:1928–1937.PubMedCrossRefGoogle Scholar
- 12.Federal Aviation Administration. Flight crewmember duties. FAR 121.542. Available at: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=21fa54465a4bfaebbc18090246f44bb4&rgn=div8&view=text&node=14:184.108.40.206.220.127.116.11&idno=14. Accessed October 11, 2012.
- 17.Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499.PubMedCrossRefGoogle Scholar
- 18.James MA, Seiler JG 3rd, Harrast JJ, Emery SE, Hurwitz S. The occurrence of wrong-site surgery self-reported by candidates for certification by the American Board of Orthopaedic Surgery. J Bone Joint Surg Am. 2012;94:e2(1–12).Google Scholar
- 21.Khuri SF, Daley J, Henderson W, Barbour G, Lowry P, Irvin G, Gibbs J, Grover F, Hammermeister K, Stremple JF. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180:519–531.PubMedGoogle Scholar
- 22.King HB, Battles J, Baker DP, Alonso A, Salas E, Webster J, Toomey L, Salisbury M. TeamSTEPPS™: team strategies and tools to enhance performance and patient safety. In: Henriksen K, Battles J, Keyes M, Grady M, ed. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools). Rockville, MD: Agency for Healthcare Research and Quality; 2008.Google Scholar
- 23.Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington DC: National Academy Press; 2000.Google Scholar
- 31.Panesar SS, Noble DJ, Mirza SB, Patel B, Mann B, Emerton M, Cleary K, Sheikh A, Bhandari M. Can the surgical checklist reduce the risk of wrong site surgery in orthopaedics? Can the checklist help? Supporting evidence from analysis of a national patient incident reporting system. J Orthop Surg Res. 2011;6:18.PubMedCrossRefGoogle Scholar
- 33.Raheja D. Safer Hosptial Care: Strategies for Continuous Innovation. New York, NY: CRC Press; 2011.Google Scholar
- 40.Stahel PF, Sabel AL, Victoroff MS, Varnell J, Lembitz A, Boyle DJ, Clarke TJ, Smith WR, Mehler PS. Wrong-site and wrong-patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences. Arch Surg. 2010;145:978–984.PubMedCrossRefGoogle Scholar
- 41.The Joint Commission. Sentinel Event Database. Available at: http://www.jointcommission.org/sentinel_event.aspx. Accessed October 11, 2012.
- 42.The Joint Commission. Universal Protocol. Available at: http://www.jointcommission.org/standards_information/up.aspx. Accessed April 22, 2012.