Adapting and incorporating some of the same safety techniques used by airline crews, the staff at Cedars-Sinai Medical Center is continually working to improve patient safety in the operating room.
One way to approach the goal of improved patient safety, according to Bruce Gewertz, M.D., Cedars-Sinai’s new surgeon-in-chief, is to follow a training program the airline industry calls “crew resource management.” Its aim is to enhance communication so that every member of a team feels empowered to speak up if they have a concern about any aspect of a passenger’s – or, in this case a patient’s – safety.
Crew resource management training began in 1979 during a NASA workshop and is now a mandated requirement for most commercial pilots. NASA research found that the primary cause of most aviation accidents was human error, and that many of the major problems were failures of interpersonal communication, leadership and decision-making in the cockpit.
A culture of non-hierarchical communication in the operating room has been heralded within the healthcare industry as a fundamental part of reducing medical errors. The Joint Commission on the Accreditation of Healthcare Organizations, the healthcare industry’s standards-setting organization, noted in one study that communication was identified as the most common root cause of wrong-site surgeries.
As one of the pacesetter health care institutions to adopt this aviation-based safety program, Cedars-Sinai, under Gewertz’ leadership, has initiated pre- and post-surgical debriefings for each surgical case.
Within a 24-hour window before each case, the staff makes certain that all the necessary equipment is organized and there’s a clear plan of action for both the staff and the surgeons. Then, immediately before the case begins, the primary staff involved in the case gather around the patient (while he or she is still alert), to discuss any special concerns the patient may have expressed earlier and confirm that these requests will be met. Finally, the circulating nurse meets with the senior surgeon after the case to ask him or her if everything went well, if they had all the instruments they needed, and how the case might be done better in the future.
The debriefings are not time-consuming, Gewertz said, and their benefit outweighs the time spent to complete them. “Over the past month since we began implementing the debriefings, we’ve been surveying our physicians both formally and informally. They’ve expressed satisfaction that their individual needs are being met,” said Gewertz.
An important element of improving communication among the operating room team, added Gewertz, is making the environment as maximally efficient as possible and eliminating distractions. “We’re doing everything we can to make the operation room a distraction-free environment so people can focus on delivering the safest, most efficient care to the patient.”
Cedars-Sinai recently built six new 600 square-foot operating rooms equipped with the latest in ceiling-mounted surgical instrumentation aimed at minimizing clutter and improving visibility throughout the operatory. Each suite has broadband videoconferencing capability and state-of-the-art digital imaging readers to speed data transmission.
Comparing aviation safety to patient safety, Gewertz contends that the latter may be more cultural than technological. “In my work at Cedars-Sinai, I’ve tried to foster operating room environments where team members understand that communication and interpersonal relationships affect surgical outcomes as much as clinical training and technology/” “We need to focus on creating and maintaining opportunities to have open, clear and respectful communication among physicians and healthcare professionals at all levels, so that everyone feels vested in the outcome of the operation and comfortable offering feedback,” he added. ”
Gewertz, who joined Cedars-Sinai on July 1, is an internationally renowned surgeon, researcher and educator with an extensive background in academic and clinical leadership. He was previously chair of the Department of Surgery and Dallas B. Phemister Professor at the University of Chicago, a position he held since 1992. He had held a number of other leadership positions, including chair of the University of Chicago Health Plan and Chair of the Board of Chicago Partners, a partnership of the academic medical center with 60 primary chare physicians.
In addition to the responsibilities of surgeon-in-chief, his new duties include chair of the Department of Surgery and vice president for interventional services. Gewertz, a vascular surgeon, has authored more than 200 scientific articles, book chapters and books.
“There are few institutions in the country that are as well-suited to implementing innovative practices as Cedars-Sinai,” Gewertz said. “We’re committed to being recognized as one of the elite hospitals in the United States.”
The first of seven hospitals in California whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 18 consecutive years, it has been named Los Angeles’ most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.csmc.edu/.
Cedars-Sinai Medical Center
8700 Beverly Blvd., Rm 2429A
Los Angeles, CA 90048