Just as we’ve discussed using different structured formats for handoffs depending on the setting and context, the same can be said for the format and structure of surgical timeouts. In fact, when the WHO Surgical Safety Checklist project was launched they encouraged that the checklist be modified for the needs of each setting (see our Patient Safety Tips of the Week for July 1, 2008 “WHO’s New Surgical Safety Checklist” and January 20, 2009 Patient Safety Tip of the Week “ ”).
A new study by Tina Rutar and colleagues at UCSF, presented at this year’s annual meeting of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and recently summarized in Medscape (Zimmerman 2012), illustrates this concept nicely. They surveyed ophthalmologists about errors made during strabismus surgery and noted that Universal Protocol would likely have prevented only 16% of the errors in this field. Strabismus surgery is prone to errors because of the multiple muscles involved in eye movements, fact that sometimes you are strengthening a muscle and at other times weakening one, and that the surgeon is typically looking at the patient upside down, adding to right/left and up/down confusion. They also noted that terminology used may lead to problems (eg. the terms “recess” and “resect” or the abbreviations “rec” and “res” probably lead to more confusion that the terms “strengthening” and “weakening”).
The article has good suggestions from this team on ways to tailor surgical checklists for strabismus surgery.
Zimmerman R. Strabismus Surgical Checklist Can Help Prevent Errors. One Third of Eye Surgeons Report Having Made Operating Room Errors. Medscape News May 7, 2012