made by the surgeon.
To help prevent
these mistakes from
occurring, conduct
three separate time
outs during the three
localization attempts
— pre-incision, post-
exposure and at the
procedure's comple-
tion — to ensure the
correct vertebrae has
been located and treat-
ed. Every member of the surgical team should be engaged in ensuring
the correct site is identified. They should stop what they're doing when
it's announced a localization attempt is about to start and focus all of
their attention on the patient, the surgeon and the intraoperative images
that are captured.
After the images are taken, the surgeon counts out loud to the tar-
geted vertebrae level. Everyone in the room should feel empowered
to question the surgeon if they don't agree with the count. The deci-
sion to begin the operation at the identified site will ultimately be the
surgeon's call, but all members of the surgical team shouldn't hesitate
to ask for another image and count if there's any doubt about the
location of the correct surgical site.
To make this confirmation process work, every person in the OR
should receive advanced training on how the localization attempts
will be done. They should be familiar with what spine anatomy looks
like while viewing live fluoroscopy images on the C-arm monitor.
They should know what the C2 and sacrum look like, where they're
1 0 4 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 2 0
CLEAR VIEW Surgeons should locate the correct surgical site based on quality
images that leave no doubt about the location of the targeted vertebrae.
