The Operating Room Environment
Anesthesiologists, who spend more time in operat-ing rooms than any other group of physicians, are responsible for protecting patients and operating room personnel from a multitude of dangers dur-ing surgery. Some of these threats are unique to the operating room. As a result, the anesthesiologist may be responsible for ensuring proper functioning of the operating room’s medical gases, fire preven-tion and management, environmental factors (eg, temperature, humidity, ventilation, and noise), and electrical safety. The role of the anesthesiologist also may include coordination of or assistance with lay-out and design of surgical suites, including workflow enhancements.
Patients often think of the operating room as a safe place where the care given is centered around protecting the patient. Medical providers such as anesthesia personnel, surgeons, and nurses are responsible for carrying out several critical tasks at a fast pace. Unless members of the operating room team look out for one another, errors can occur. The best way of preventing serious harm to a patient is by creating a culture of safety. When the safety culture is effectively applied in the operating room, unsafe acts are stopped before harm occurs.
One tool that fosters the safety culture is the use of a surgical safety checklist. Such checklists are used prior to incision on every case and can include components agreed upon by the facility as crucial. Many surgical checklists are derived from the surgical safety checklist published by the World Health Orga-nization (WHO). For checklists to be effective, they must first be used; secondly, all members of the surgi-cal team should be engaged when the checklist is being used. Checklists are most effective when performed in an interactive fashion. An example of a suboptimally executed checklist is one that is read in entirety, after which the surgeon asks whether everyone agrees. This format makes it difficult to identify possible problems. A better method is one that elicits a response after each point; eg, “Does everyone agree this is John Doe?”,followed by “Does everyone agree we are performing a removal of the left kidney?”, and so forth. Optimal checklists do not attempt to cover every possibility but rather address only key components, allowing them to be completed in less than 90 seconds.
Some practitioners argue that checklists waste too much time; they fail to realize that cutting corners to save time often leads to problems later, resulting in a net loss of time. If safety checklists were followed in every case, significant reductions could be seen in the incidence of surgical complica-tions such as wrong-site surgery, procedures on the wrong patient, retained foreign objects, and other easily prevented mistakes. Anesthesia providers are leaders in patient safety initiatives and should take a proactive role to utilize checklists and other activi-ties that foster the safety culture.