Episode 11: Thinking About Patient Safety in the Domain of Surgical Care
August 9, 2013
In this episode Dr. Marcia Clark discusses patient safety in terms of surgical care. There is an apparent higher rate of error that occurs in surgical patients; a 5.5% incidence of error in surgical patients versus 3.5% for non-surgical patients. Of the 5.5% of errors in surgical patients, there is a 29% fatality rate and a rate of 13.5% for wrong-sided surgery. The three highest risk areas for error to occur in medicine are the operating room, the emergency room, and the intensive care unit; all areas where surgeons work. These are also areas where complex and multi-faceted care takes place, with many teams and systems working together to care for the patients. In the operating room Marcia interacts with as many as seven different teams even when taking care of relatively stable patients whose injuries are non-life threatening. This high level of interaction required to care for surgical patients creates more opportunities for errors to be made than for patients who may only have one team looking after them.
Marcia also describes the seven phases of surgical care where error can occur:
- Initial assessment and diagnosis of surgical disease
- Patient selection for surgery
- Timing and planning of surgical intervention
- Immediate pre-operative care
- Technical aspects of surgical procedures
- Post-operative care
- Discharge and medication reconciliation
Lastly Marcia outlines four steps that can be used to mitigate and prevent errors in surgical practice. These include simulation based training, techniques and checklists for improving patient hand-offs, safe-surgery checklists, and expansion and revision of the Royal College of Physicians and Surgeons CanMEDS competencies to renew the focus on patient safety.
After listening to this podcast listeners will be able to:
1. Explain the aspects of surgical care that may influence the higher rate of error seen in these patients versus non-surgical patients
2. List the seven phases of surgical care where error can occur
3. Describe the four practices described by Marcia that are used to mitigate and prevent errors in surgical practice
4. Think of other possible solutions that could be used to decrease the rate of error in surgical patients
Marcia Clark, MD
Marcia is an Orthopaedic Surgeon at the South Health Campus in Calgary, Alberta and Clinical Associate Professor at the University of Calgary. She completed her undergraduate degree at the University of New Mexico (Albuquerque) and her medical degree at the University of Calgary followed by Orthopaedic Residency training at the University of Alberta. Marcia completed two Fellowships. Firstly, a Hip and Knee Reconstruction Fellowship, at the Wakefield Clinic and University of Adelaide in Adelaide, South Australia. Her second Fellowship was at the University of Calgary in Surgical Education and Revision Joint Arthroplasty where she earned a Master of Science in Medical Education. Marcia’s clinical interests involve complex primary and revision hip and knee surgeries. Additionally, she is an active member of the Canadian Alpine Ski Team Medical group, providing care for athletes and support staff at National and International level. She also in involved in the Indy and Formula 1 international motor sports events providing medical care. She recently earned her Diploma in Sports and Exercise Medicine. Academically, her area of expertise is in curriculum design and evaluation and a special interest in the use of simulation in medical education, specifically around non-technical skills. She has an active role in post-graduate surgical education assisting in curricular change of the Surgical Foundations program at local and National Levels. Marcia has an Advisory role with the Royal College of Physicians and Surgeons of Canada in the CanMEDS 2015 project, the Simulation Educators Course and is a member of the new CanMEDS Academy of Educators.
References
Stahl K, Brien S. Reducing patient errors in trauma care. In: Cohn S, editor. Acute Care Surgery: Evidence Based Practice. 3rd edition 2013.
Stahl K, Brien S. Optimizing Patient Safety in Surgery 2013. In: Complications in Surgery of Trauma 2nd edition.
To see the Safe Surgery Checklist, a WHO initiative used in almost every ER in Alberta, click here