Using an OR Checklist

Surgeon
A plastic and reconstructive surgeon discusses how to ensure consistent and highly-reliable surgical procedures in the operating room.

Predictability and high-reliability will be key to procedures at Intermountain in 2018. Peer-reviewed literature agrees on their importance, and the World Health Organization has created a safe surgery checklist. Dr. Rob Ferguson, Plastic and Reconstructive Surgeon at Intermountain Medical Center, sat down with Dr. Shannon Phillips, Intermountain’s Chief Patient Experience Officer at Intermountain, to discuss the benefits of practice consistency in the operating room.

Predictability and high-reliability will be key to procedures at Intermountain in 2018. Peer-reviewed literature agrees on their importance, and the World Health Organization has created a safe surgery checklist. Dr. Rob Ferguson, Plastic and Reconstructive Surgeon at Intermountain Medical Center, sat down with Dr. Shannon Phillips, Intermountain’s Chief Patient Experience Officer at Intermountain, to discuss the benefits of practice consistency in the operating room.

“High reliability is something Intermountain Healthcare expects,” says Dr. Ferguson. “When we do things with consistency, it helps highlight things that may be out of the ordinary.” While most surgeons have their own mental “checklist,” there isn’t a consistent, system-wide guide for performing procedures. “I do think, to create a high reliability organization, we should have specific steps in place to allow us to define things we may already be doing,” says Dr. Ferguson. “Steps such as communicating what is needed for the patient with the team, and that we have everything we need to ensure the procedure goes as well as possible.”

Input from every member of the team is important, and when the patient is prepared and draped off, the team verifies that the procedure is to take place in that exact location, antibiotics have been given, or whatever is appropriate for the procedure. “This is an opportunity for that team to connect on what they are doing in that moment,” says Dr. Phillips. Dr. Ferguson agrees, “I also think that to have specifically deliberate, consistent steps at each phase of the procedure would be really helpful.”

Once the procedure is over, there needs to be a debriefing. “We need to make sure we really did have everything, and if there is something we need to do differently next time, we make that better,” Dr. Ferguson says. “And we need to ensure that the next phase of care is prepared to receive that patient appropriately.”

A Joint Commission team led by Chassin and Loeb (2013) found that poor communication within and between teams is a common problem in healthcare. Using a checklist that proposes critical steps before, during, and after a surgery can help caregivers minimize the most common—and avoidable—risks to surgical patients. “Keep an open mind, dig in, and understand how this might actually raise everybody’s game in caring for patients every day,” says Dr. Phillips. “Consistency can only make us better.”

To hear more from this podcast with Dr. Phillips and Dr. Ferguson, click here.