A ‘surgical huddle’ saves lives


Marjorie Scott quietly reads a book as she sits in the waiting room just inside Royal Victoria Hospital’s operating suites.

On this day she is having her gall bladder removed and there is only one thought on her mind – yogurt and fruit.

“That’s the first thing I’m going to eat once I have this surgery. Of all the foods I have had to cut out of my diet to control this condition those are the two I miss the most,” says Scott, 61, who has suffered six severe gall bladder attacks in the last six months.

What’s not on her mind is safety. She has complete confidence in Barrie’s RVH surgical team.

That’s because she knows that while she sits and reads her paperback, behind the closed door of the operating room something crucial to the success of her surgery is taking place.

Like all surgeons at RVH, Dr. Michael Anderson has gathered with the team for today’s ‘huddle’, formally beginning a process called the Surgical Safety Checklist.

This process was initiated by the World Health Organization in 2008 through the “Safe Surgery Saves Lives” campaign. The campaign was prompted from a survey which conclusively revealed that a surgical checklist reduced both surgical complications and deaths.

This protocol became a reportable public safety indicator in April as mandated by the Ministry of Health and Long Term Care. The results of the first three months of data were released by the Ministry in July and RVH scored exceptionally well. RVH is pleased to report a SSCL compliance rate of 99.73 per cent.

All patients having surgery at RVH can expect to have the checklist performed during their procedure. The only exception would be life-threatening emergency surgeries where time does not permit such a protocol to take place or cases with unforeseen complications such as airway difficulties or cardiac compromise. This could prevent one or more of the checklists’ three phases from being performed, which lead to RVH’s slightly less then 100 per cent compliance rate.

“The Surgical Program is very proud of our success in adopting and implementing the Surgical Safety Checklist,” says Dr. Don DuVall, RVH Chief of Anaesthesia and Clinical Director of Surgery. “Worldwide evidence supports the benefits of the checklist as a significant patient safety initiative. The Surgical Team and the Safety Checklist Champions that led the project are the ones who deserve the recognition and thanks for making this program such a positive achievement.”

Under the leadership of RVH’s Surgical Safety Checklist Project Team – comprised of project lead Mary Lambert, perioperative clinical educator, surgeons Dr. Cory Hartzburg and Dr. Kamla Maharajh and anesthesiologists Dr. Jane Brasher and Dr. Amy Thiele-Kuntz as well as Troy Tarasco, manager of perioperative services and perioperative RN Mona Sheppard, RVH began using this system in September 2009.

“Patient safety is a top priority at RVH, in fact, it is one of our overarching strategic directions. We are first and foremost, committed to the safety of our patients,” says Dr. Martin Lees, Vice-President, Chief Medical Executive and Chair, Medical Advisory Committee, Royal Victoria Hospital. “Operating room teams have used different types of checklists for many years. The three-phase SSCL has emerged as a useful best practice because it organizes the information at the right moments in time.”

During this huddle the surgeon, anesthetist, and the attending operating room nurses, gather to share vital information about each of the five patients on the roster today. The team goes through surgical and anesthesia requirements for the day and nursing concerns on a patient-by-patient basis.

First up in the conversation is Marjorie Scott.

Led by Dr. Anderson, the surgical team meticulously completes a detailed list of questions which involves reviewing Scott’s chart for medical history, making sure the appropriate monitoring equipment and all of the necessary supplies are ready and available. Dr. Anderson is familiar with this case and shares some details he knows that are not on the charts. This is what makes this point in the day so important. Dr. Anderson likens the “huddle” to the communication that goes on in the cockpit of a plane.

“Open communication between all the team members is the way to eliminate any mistakes or problems down the road,” says Anderson. “Everyone is on the same level during these huddles and able to put forth any concerns or questions they may have.”

Operation room nurse, Jenn Miller, agrees.

“This is our time to ask any questions or bring any concerns about a patient to the group,” says Miller. “We discuss our cases for the whole day and this helps us better prepare for the day. No surprises means better care for the patient. We don’t want to be caught off guard.”

This morning’s huddle reveals that the next patient has difficulty with sedation, Miller quickly leaves the room to retrieve new equipment but before she goes, she makes another call about another patient’s specific religious request.

“For the surgical team it adds another layer of checks and balances that functions to catch potential errors from occurring. This translates directly to improved quality of care and overall team performance. As a patient, I would be very happy to know that another layer of quality assurance is there to protect me,” says Shawn Virtue, director of the RVH Surgery Program.

This ‘huddle’ inspires communication and team work and ultimately the end result is a high standard of patient safety.

And that’s great news for Marjorie Scott.

“Any extra step the surgical team can take to make sure I’m getting the right operation under the safest conditions is a good idea,” says Scott.

As she walks into the OR, Dr. Anderson greets her and confirms that she is indeed here for gall bladder surgery, and other details, all part of the checklist called Sign in – before Induction (operation begins).

Scott teases him and asks if he can drive her home after the surgery because they live on the same street.

Unfortunately, he declines; he has a very busy day ahead of him.

When Scott is fully sedated and before the first incision is made, the team gathers for the Surgical Pause to once more check patient information and make sure there are no other concerns not identified in previous discussions.

Once Scott’s surgery is complete the team again assembles and completes one last check called – Sign Out Before Transfer – where they discuss any concerns regarding her recovery or destination, address any perioperative problems and ensure all paperwork is complete.

During the entire process Scott is blissfully asleep with visions of yogurt and fruit dancing in her head.