June 1, 2018
The American College of Surgeons (ACS) Board of Governors Surgical Care Delivery Workgroup recently revised and updated the ACS Statement on Surgical Patient Safety to focus on team care. The original statement was developed by the Board of Governors Committee on Surgical Practice in Hospitals and Ambulatory Settings and was approved by the Board of Regents in October 2008. The Board of Regents approved the revised statement at its June 2018 meeting in Chicago, IL.
The ACS regards patient safety as a top priority. Individual hospitals and health care organizations are strongly encouraged to develop guidelines to ensure optimal patient safety in the operating room. One important component is the use of a “team approach” that engages all parties involved in the surgical process.1,2 Whereas a lack of effective communication and failure to coordinate care are the most common causes of medical errors, incorporation of team-based practice through institutional team training is an important early step.3 One standardized curriculum is the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program developed by the U.S. Department of Defense, which focuses on leadership, situation monitoring, mutual support, and communication.4
Reliable methods for investing preoperative and postoperative briefing and debriefing into institutional culture should be developed. Standard processes for identification of the patient, procedure, operative consent form, and the surgical site should be mandatory and performed prior to the patient entering the operating room (OR). In the OR, a time-out or surgical pause helps avoid errors and fosters communication among surgical team members.5,6 For procedures involving multiple surgeons, clinical team leaders or their designees are responsible for verifying the details of their portion of the operation. All relevant records, images, and essential equipment should be called out and availability confirmed. If any part of the verification process is incomplete, OR activity should be halted until verification is successfully completed.
The ACS recognizes that the use of computerized medical records and barcoding of drugs and blood products are highly desirable throughout all perioperative areas. Computerized preference cards help avoid multiple trips by support staff from the OR during the procedure. It also is important that during high-risk portions of procedures, the team should agree on specific no-handoff times during which certain members of the team will not be changed. Safe practices as recommended by the ACS and The Joint Commission—including, but not limited to, double-gloving, blunt-tip suture needles, neutral zones, and protective sharps devices—protect team members and the patient.7 In addition, the ACS condemns disruptive behavior from any member of the OR team, as such behavior jeopardizes patient safety.8
To enhance patient safety, it is the responsibility of the surgeon to engage in the following activities:
The ACS offers this statement for consideration by surgeons, their hospitals, and health care organizations. This statement is provided as general guidance. It does not constitute a standard of care and is not intended to replace the professional judgment of the surgeon or health care administrator.
This statement may be reviewed and modified as necessary to conform with the laws of the applicable jurisdiction, the circumstances of the individual hospital and health care organization, and the requirements of other allied and health care organizations.
Related statements include the following:
Reprinted from Bulletin of the American College of Surgeons
Vol. 103, No. 9, September 2018