About Operating Room Safety

 Make Sure You’re in the Safest Possible Operating Room

The Hazards of Hospitals

We all think of the hospital as a place we go to get better, but hospitals in the United States are making people sicker at alarming rates. Between overtired interns, germ-covered doctors,  haphazard record keeping, and equipment failures, you might find yourself in more trouble than you were when you checked in. Here are some alarming statistics, followed by some patient recommendations.

• 1.7 million infections are contracted in hospitals each year.
• 1 in 5 patients suffer harm from medical errors, and 99,000 die from them.
• You’re 30,000 times more likely to die from a hospital visit than a plane crash.
• And more die from infections each year than from car accidents, breast cancer or aids.

High Anxiety

The simple mention of having a medical procedure brings out anxiety in most people. It’s human nature to become fearful when preparing to undergo a surgical procedure that requires in-patient treatment, sedation and operating rooms, as it is associated with pain and mortality. Operations can be so stressful on a person that the Journal of the Chinese Medical Association’s September 2014 issue says there is a link between pre-procedural anxiety and the patient’s recovery. One way to lower the level of preoperative fear is fully understanding the safety procedures and precautions of the medical facility.

The Almighty Checklist

The biggest threat to safety in a hospital is the people. Over the last few decades, morbidity rates of hospital operations have dropped radically, yet there are always going to be unexpected occurrences and they are often credited to human error (i.e. distractions and forgetfulness). In order to reduce many of these avoidable incidences, research printed in the 2014 Journal of Patient Safety says procedural checklists are highly conducive to increasing communication, reducing errors and improving efficiency. As a patient, you can ask your surgical nurse to see the checklists of operating procedures. Understand that you will probably not understand most of what is on the list but it will give you a sense of safety knowing that such a document exists and is being followed.

Know The Hands

If you are having your operation at a teaching hospital, there is the possibility that some of the procedure will be done by a surgical resident. Research by the Annals of Surgical Oncology November 2013 issue shows that there are positive and negative aspects to facilities that use residents. Because a resident is still technically learning, there is a greater risk of error during the procedure. This is countered by better post-operative care. As part of the pre-operative conference, ask to meet anyone that will be laying hands on or in you, especially a surgical trainee.

The Right Tool

Human error is one source of concern; mechanical error is another. Unfortunately, one fifth of all operating room errors are caused by equipment malfunction or failure, accordingly to research printed on July 25, 2013 in the BMJ Quality and Safety Journal. To lessen your anxiety about the surgery, do some research on any major device that will be used. Especially understand medical devices that may be put in your body as part of the procedure, such as medical seals, pace makers and joint replacements. This is another situation where you may wish to see a checklist. It will give you an idea of the types of equipment being used and the risk of mechanical failure. For your own well-being, after seeing the list, actively force yourself to relax, lower anxiety, and trust in the skills of your physician.

Man And Machine

One of the greatest technological steps in creating a safe operating environment is the inclusion of robotically assisted surgery. Under the guidance of the surgeon, medical machines are programmed and used to perform the operation with a reduced risk of human or mechanical error. Robotic assisted operations are not a conveyor belt mechanization like you see in auto manufacturing. Instead it is a synthesis of human and machine where the instrument takes over the time consuming and often risky tasks like laparoscopic suturing. The less time that patients are on the operating table, the better it is for their recovery. If safety is a concern then look at robotically assisted surgery as one of your treatment options.

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Safety, Quality & Price as Threat or Competitive Advantage

If U.S. hospitals don’t significantly improve their outcomes and prices, they may not survive, because more consumers now have an incentive to shop for the best value in health care as the insurance industry shifts away from service as prepaid medical care and instead toward protection against catastrophic illness & injury.

Insurance reform was one of the Healthcare MiniTrends I wrote about last month, when I said 429 of the original Fortune 500 companies [1955] are no longer in business today. That should be a scary thought for those sitting at the top of the healthcare mountain looking down at hungry competitors and their disruptive technology focused on safety and value.

Comparing Health Care and Aviation

A 1999 report by the Institute of Medicine, titled “To Err Is Human,” estimated that as many as 98,000 patients die each year in hospitals from preventable medical errors. That’s the equivalent of two wide-bodied jets crashing every day and, while our nation wouldn’t stand for that, medical errors have not gotten the same attention as airline safety. Healthcare can also learn from airline service, as bad as it is, as shown in this satirical video.

The number of accidental deaths in a jet aircraft has been reduced from 5 people per million passenger miles in 1965 to less than 0.0003 in 2009, thanks to safety improvements across the aviation industry. We need similar improvements in health care safety.

But maybe the real comparison should be with the computer industry. After all, it has been suggested that if the airline industry had improved at the same rate as the computer industry over the last 30 years, you could fly from New York to London in one second at a cost of one cent. And once at your destination, it would be cheaper to throw the 2-inch long airplane away than to have it serviced and parked overnight. Such is the impact of Moore’s Law on the future of health care.

Tort Reform.

From the stats I’ve seen, we have a medical errors problem, not a frivolous lawsuit problem, and tort reform may be making it worse by preventing legitimate suits and access to the court system that would act as a more natural deterrent. The insurance industry is largely responsible this by promoting fear of lawsuits so they can sell malpractice insurance policies.

Better than tort reform would be price transparency and new online ratings systems, like Angie’s List for medicine. Given a chance, the risk-reward pressures of free-market capitalism could go a long way toward rewarding the best practitioners and weeding out the bad. In his TIME Magazine special report, Bitter Pill: Why Medical Bills are Killing Us, Steven Brill calls for more up front transparency of charges and the elimination of the hospital ChargeMaster who keeps charges secret.

Health Reform’s Technology Focus

While technology alone can’t prevent medical errors or cure our sick healthcare system, computers are better than doctors at (1) organizing and recalling data; (2) integrating and balancing considerations of patient symptoms, history, demeanor, environmental factors, and population management guidelines; and (3) having much lower error rates.

Obamacare emphasizes health information technology (HIT) with the goal of creating a seamless system of care as well as reducing medication errors that injure 1.5 million Americans and cause more than 100,000 deaths annually. The new law encourages the formation of Accountable Care Organizations and shared access to electronic medical records among specialists in coordinated care teams. The idea is to reward organizations that cut costs by focusing on preventing medical errors, hospital readmission, and unnecessary procedures.

Providers once complained about the lack of proper information at the point of care, whether it’s primary care, home care or ambulatory care, since this can become critical during emergency situations. That’s why smartphones are now being loaded with clinical decision support information to help physicians make better diagnoses in all patient care settings. These mobile and web-based tools offer easy to access information on proper treatments and can help prevent medical errors, reduce adverse drug events, and reduce preventable hospital readmission.

TeleHealth Trend

Web-based video chats between doctors and patients aren’t new — it’s been used in varying degrees for a few years now. But health reform, a ballooning and aging population, and a shortage of available family physicians may be a perfect storm that could blow the doors open for telehealth to go mainstream.

As incredibly innovative and efficient as telehealth is at providing greater access to care for consumers, lowering healthcare costs for both patients and healthcare systems, and improving outcomes, barriers have always existed that hinder its widespread adoption. Yet recently, issues such as state licensure, reimbursement, and a general resistance from old-school physicians are quickly evaporating in the wake of the overwhelming proof of telehealth’s many benefits.

Medical Tourism Trend

With more price transparency and low-cost / high deductible insurance policies, consumers have new incentives to seek the best value. And they are comparing providers across town or across state lines. Over 8 million people worldwide, and 1.3 million Americans, even cross international borders for better and cheaper care.

There are many options for great care in places like Argentina, Brunei, Cuba, Colombia, Costa Rica, Honk Kong, Hungary, India, Jordan, Lithuania, Malaysia, Mexico, The Philippines, Singapore, South Africa, Saudi Arabia, South Korea, Thailand, Tunisia, and UAE. In Malaysia, for example, you can save 65-80% over the cost of having a procedure done here, and often the total cost, including airfare and 5-star hotel on the beach for recovery, is less than the annual insurance deductible.