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KEY POINTS

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  1. Patient harm due to medical mistakes can be catastrophic and, in some cases, result in high-profile consequences not only for the patient, but also for the surgeon and institution.

  2. Patient safety is a science that promotes the use of evidence-based medicine and common sense improvements in an attempt to minimize the impact of human error on the routine delivery of services.

  3. The structure-process-outcome framework within the context of an organization’s culture helps to clarify how risks and ­hazards embedded within the organization’s structure may potentially lead to error and injure or harm patients.

  4. Poor communication contributes to approximately 60% of the sentinel events reported to The Joint Commission.

  5. Operating room briefings are team discussions of critical issues and potential hazards that can improve the safety of the operation and have been shown to improve operating room culture and decrease operating room delays.

  6. National Quality Forum surgical “never events” include retained surgical items, wrong-site surgery, and death on the day of surgery of a normal healthy patient (American Society of Anesthesiologists Class 1).

  7. Patient rapport is the most important determinant of ­malpractice claims against a surgeon.

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BACKGROUND

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Patient harm due to medical mistakes can be catastrophic, resulting in high-profile consequences for the patient, surgeon, and institution. A single error can even destroy a surgeon’s career. While mistakes are inherent to human nature, it is becoming more recognized that many mistakes are preventable.

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Patient safety is a science that promotes the use of ­evidence-based medicine and local wisdom to minimize the impact of human error on quality patient care. Wrong-site/wrong-procedure surgeries, retained sponges, unchecked blood transfusions, mismatched organ transplants, and overlooked allergies are all examples of potentially catastrophic events that can be prevented by implementing safer hospital systems. This chapter provides an overview of the modern-day field of patient safety by reviewing key measures of safety and quality, components of culture, interventions and tools, and risk management strategies in surgery.

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THE SCIENCE OF PATIENT SAFETY

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Medicine is considered a high-risk system with a high error rate, but these two characteristics are not always correlated. Other high-risk industries have managed to maintain an impeccably low error rate. For example, one of the highest risk systems in existence today, the U.S. Navy’s nuclear submarine program, has an unmatched safety record.

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Much of the credit for their safety record is due to the culture of the nuclear submarine program, with its insistence on individual ownership, responsibility, attention to detail, professionalism, moral integrity, and mutual respect. These characteristics have created the cultural context necessary for high-quality communications under high-risk, high-stress ­conditions. Each reactor operator is aware of what is going on at all times and is responsible for understanding the implications and possible consequences of any action. Communication flows freely between crewmen and officers, and information about any mistakes that occur are dispersed rapidly through the entire ...

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