WHO SURGICAL CHECKLIST IN THEATRES

WHO Surgical Checklist in Theatres

WHO Surgical Checklist in Theatres

Introduction

In the light of patient safety medical errors specifically operating on the wrong site or body part represents a potentially devastating event for the patients, their concerned ones and the surgeon himself.

Medical errors relating to wrong-site surgery are tragic for the patient and damage awards against doctors, hospitals and other health care providers. Outstanding studies of medical error have used retrospective chart review to quantify adverse event rates.

Rationale for Change= WHO Checklist

1. Has the patient confirmed his/her identity, site, procedure and consent?

Yes

2. Is the surgical site marked?

Yes/not applicable

3. Is the anaesthesia machine and medication check complete?

Yes

4. Does the patient have a: Known allergy?

No

Yes

5. Difficult airway/aspiration risk?

No

Yes, and equipment/assistance available

6. Risk of >500ml blood loss (7ml/kg in children)?

No

Yes, and adequate IV access/fluids planned

“Medical errors are usually considered to be preventable adverse medical events." (Brennan, Leape, Laird, et al 1991)

Errors in medical care are revealed through a variety of mechanisms. Historically, medical errors were revealed retrospectively through morbidity and mortality committees and malpractice claims data.

Change Management in Hospitals

There is one important aspect that make leadership and change management particularly challenging in the hospital industry. Most hospitals are run by two top executives: the hospital administrator, in charge of the employees and the business functions, and the medical doctor who is in charge of the doctors and the clinical processes. Most businesses and institutions have only one chief executive. There are few other two-headed organizations. The closest analogies would be the publishing industry co-run by publishers and the editor-in-chiefs, and the film business co-operated by producers and directors. There would be inherent dichotomies, tensions, and complexities in organizations with two bosses. The typical question is who is more important: the hospital administrator or the medical director. Who is the tail? the dog? Who should wag who? Who should lead the change? Who decides the long-term strategy for the hospital? The answer is both: the two heads should think with one head in deciding fate and future of hospital and its stakeholders. This is easier said than done, but it has to be done. One reason for the slow pace of change in a hospital may be the lack of shared vision and commitment from the hospital administrator and the medical director.

In addition to acting in unison, each head should have strong personalities and leadership. Both have unique groups of people to manage to ensure quality service. Administrators have nurses under them, the biggest group which also has a high turnover. Typical hospitals suffer from scarcity of nurses, and those who remain are overworked and overloaded, and are constantly being wooed away by U.S. and U.K. hospitals. Hospital administrators will have to formulate long term strategies given this scarce and transient resource.

On the other hand, the biggest challenge of medical directors is managing, coordinating, and disciplining doctors. Doctors, or more precisely consultants, wear three hats: employee, customer, and owner. They act like employees. Though receiving no salaries from hospitals, they perform ...