Using Readbacks to Enhance Patient Safety

Using Readbacks to Enhance Patient Safety

Normal readback orders have been recommended as a patient safety initiative for physicians, surgeons, and staff in order to reduce the incidence of perioperative complications that can result from verbal communication breakdowns. “Many hospitals nationwide have started to implement readbacks as a mandatory protocol, but progress in adopting this strategy has been slow,” says Philip F. Stahel, MD, FACS. “Few studies have assessed the feasibility and acceptability of readbacks among operating room (OR) staff.” Perceptions & Barriers to Readback Implementation In BMC Surgery, Dr. Stahel and colleagues had a study published that aimed to understand the perceptions of and barriers to implementing readbacks from the viewpoint of OR personnel. “We also wanted to determine the willingness of OR personnel to attend future training modules and specific scenarios in which readbacks may be effective,” Dr. Stahel says. Results were then compared between surgery and anesthesia departments and between specific staff roles, including attending or midlevel providers, resident physicians, and nursing staff. “Our results showed that respondents overwhelmingly believed readbacks help reduce communication errors and improve patient safety,” says Dr. Stahel. “Most respondents—both from surgery and anesthesiology departments—strongly agreed that participating in readback training programs would be beneficial. Resident physicians, however, were less likely to feel that readbacks reduced communication errors when compared with other providers and nursing staff. They were also less willing to attend short training modules on readbacks.” Overall, readbacks were believed to have an important role in patient handoffs, patient orders regarding critical results, counting and verifying surgical instruments, and delegating multiple perioperative tasks. “The biggest challenge in implementation, however, appeared to revolve around determining what kind of...

Lessons Learned From Wrong-Site, Wrong-Patient Surgery

Interventions involving a wrong site, wrong patient, or wrong procedure represent an unacceptable surgical complication. Although relatively rare, the results can be catastrophic for patients and physicians alike when wrong-site, wrong-patient surgeries occur. Several national organizations have released recommendations for hospitals and healthcare organizations to develop guidelines that ensure correct-patient, correct-site, and correct-procedure surgery. In 2004, the Joint Commission introduced a Universal Protocol for all accredited hospitals, ambulatory care facilities, and office-based surgical facilities. It consists of three distinct parts: 1) a pre-procedure verification, 2) a surgical-site marking, and 3) a “time-out” performed immediately before the surgical procedure. “Despite the widespread implementation of the Universal Protocol in recent years, wrong-site surgery continues to pose a significant challenge to patient safety,” says Philip F. Stahel, MD, FACS. “We lack reliable data about the true incidence of wrong-patient and wrong-site operations largely because these confidential data may represent just the tip of the iceberg of the most severe occurrences.” In previously published studies, investigators have found that only about one-third of all wrong-site surgery cases result in legal action. It has also been estimated that the Joint Commission event database accounts for just 2% of all wrong-site procedures occurring in the United States. A Common Problem Despite Improvement Efforts In the October 2010 Archives of Surgery, Dr. Stahel and colleagues published an analysis of a prospective physician insurance database in Colorado, which contained more than 27,000 physician self-reported adverse occurrences between January 2002 and June 2008. Over the 6.5-year period, physicians reported 25 wrong-patient and 107 wrong-site procedures to a liability insurance database (Table 1). “Wrong-site, wrong-patient procedures are happening more often...