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What's the Harm? - December 2015 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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3 9 D E C E M B E R 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T More detail, less time In January 2009, the same month the New England Journal of Medicine published the WHO checklist, I published an article (osmag.net/qB8XKu) in the Plastic and Reconstructive Surgery Journal. In it, I detailed a checklist protocol I'd developed — one that starts the first day the patient comes in for a consult — even though the surgery may be months later. From that first visit on, the checklist follows a path, with action items that continue until the day of surgery. But hold on. Let's take our own time out right here, because usually when I start talking about this, surgeons worry that it sounds like too much work. Well, I have good news: I don't touch the checklist. I cre- ated it and I edit it when necessary, but it's my staff members who go through all these steps. They all have parts they're responsible for and they can all access it. The additional work required for nurses or sur- geons is nonexistent, because they'd have to be doing all these things anyway. The point is, you need to be on top of things and accumulating data from the moment the patient first arrives. If a patient has an allergy, we need to make sure we have an alternative. If she has high blood pressure, I need to speak to her doctor. The time to do that isn't a week in advance, because if you change a drug, it may take weeks or even months to stabilize. It may also take weeks or months to get a patient's records. And when I do, I might find out she had a problem with anesthesia in the past. If so, I'll need to talk to anesthesia long before the day of surgery. Hospitals and ASCs tend to focus on errors of commission, but not errors of omission. Those typically don't get acknowledged. The checklist helps us make sure everything that needs to happen hap- pens, and that it happens in the right order. By doing so, it actually saves time.

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