Best Practices & Benign Disease
Introduction & Objective : The Joint Commission Universal Protocol aims to increase patient safety by avoiding "never-events" involving the wrong patient, surgical site, or procedure. Recently, additional preoperative requirements at Penn State Health Milton S. Hershey Medical Center were implemented including attending surgeon attestation of surgical H&P and consent at patient bedside on the morning of surgery. We evaluated whether these added safety policies had an early impact on several key institutional OR performance indicators and reported patient safety events compared to the previous year.
The key institutional OR performance indicators from the first 3 quarters (Q1-Q3) of Fiscal Years 2017 and 2018 were reviewed. These included total case volume, OR utilization, first case on-time start rate, and average turnover time. The new requirements for attending surgeon H&P and consent attestation were implemented on July 1 2017. Available data for the Department of General Surgery as well as Division of Urology were included. All reported perioperative patient safety events were reviewed and grouped into select categories. Patient safety events unrelated to the preoperative checklist and events that were not authenticated by Risk Assessment were excluded. Two-sample t-test, Chi square, and Fisher's exact test were performed for statistical analyses.
Results : The key institutional OR performance indicators including total case volume (p=0.01), OR utilization (p=0.05), first case on-time start rate (p<0.0001), and average turnover time (p<0.0001) were all statistically significant between Fiscal Year 2017 and 2018. There were 87 reported perioperative events in FY 2017 compared to 55 events in FY 2018 (p=0.011), of which 58 events were consent-related in FY 2017 compared to 33 events in FY 2018 (p=0.016). There was no statistically significant difference in case booking error, inadequate surgical prep, missing patient ID bands, or miscellaneous reported events between FY 2017-2018.
Operative safety checklists and procedures are essential to minimize untoward events. These results highlight a decreased total number of reported perioperative events, primarily consent-related issues, after implementation of an added safety checklist attestation. Nonetheless, it is important to recognize that additional preoperative surgical safety processes can impact conventional metrics of productivity, including total case volume, OR utilization, first case on-time start rate, and average turnover time. These findings may be an early consequence of initial adoption and future study is necessary to determine if these effects persist over time.