Rhode Island hospitals agree to uniform surgical patient safety practices

All 14 hospitals in Rhode Island have agreed to adopt a uniform set of precautions to prevent surgeons from operating on the wrong body part or committing other grievous errors.

The Associated Press and Providence Journal both reported on the development. Doctors and hospital officials said Tuesday that following the same procedures before surgeries — no matter which hospital they are working in — will improve communication and reduce the potential for errors.

The new steps include having two licensed providers mark the place on the patient where the operation is to occur and requiring surgeons to mark the spot with their initials and use a checklist before surgeries.

The goals are to help doctors who work at multiple hospitals and reduce the potential for operating on the wrong part of the patient or other mistakes.

The protocol has several features that will require the state’s roughly 300 surgeons and thousands of operating-room nurses to change the way they work:

1. The surgical site is marked after a three-way consultation with the surgeon, one other licensed practitioner (such as a nurse) and the patient or patient’s guardian. Once all three agree on the site, it is marked with the surgeon’s initials.

2. The operating room team follows a briefing process. All team members introduce themselves and state their roles. The surgeon identifies the patient, the procedure and the site, and discusses the plan for the surgery, including the patient’s medications, lab or imaging documentation and necessary equipment.

3. The surgeon initiates a time-out before the operation, in which everyone agrees on the patient, procedure and site, and verifies that the surgeon’s initials are visible after prepping and draping.

4. Before leaving the operating room, the surgeon leads a debriefing process that includes reviewing the postoperative plan of care and discussing what worked well and what could have been done differently.

In announcing the new rules Tuesday, the Hospital Association of Rhode Island said Rhode Island is the first state in which a uniform protocol has been voluntarily adopted by all surgical providers. The protocol was developed over 18 months of consultation with hospital and health-care leaders and the Joint Commission, the agency that accredits hospitals.

All the providers — 12 hospitals and 21 surgical centers –– agreed to start rolling out the protocol on Wednesday, but it is expected to take a year before every organization has trained staff and fully implemented the new rules.

(SOURCES: The Advisory Board Daily Briefing, http://advisory.com, July 2, 2009; The Providence Journal, http://projo.com, accessed July 7, 2009)