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.
