Providing dependably excellent care for all patients all of the time is the essence of high reliability healthcare, as defined by the Joint Commission in its 2013 report. Two large health systems—Kaiser Permanente and Cincinnati Children’s Hospital—are on the path to becoming highly reliable organizations. In recent years, improved processes…
Using the right type of water for instrument reprocessing can prolong the life of medical instrumentation, contribute to effective function, and—most importantly—minimize the risk of adverse patient outcomes from contamination. The water quality requirement for various stages of instrument reprocessing depends on the type of instrument and the disinfection or…
The decision to add a new procedure in an ambulatory surgery center (ASC) is a matter of weighing risks and opportunities. A long list of variables must be analyzed and compared. Is the prospect of higher profit worth the investment that will be required in staff and equipment? Is our…
Studies have estimated the incidence of retained surgical items (RSIs) as one in 5,500 to one in 6,975 cases. In October 2013, The Joint Commission issued a Sentinel Event Alert on RSIs, and periodic reports in the media have raised the public’s awareness of this persistent problem. Effective policies, reliable…
As the anesthesiologist places the mask on the little girl’s face, the circulating nurse snaps a photograph and sends it to her parents’ cell phone with a caption saying, “she is safely off to sleep.” The nurse continues to send photographs and videos of the girl’s heart procedure along with…
New research shows that even a modest 10% reduction in the proportion of emergency surgical procedures for three common conditions could save nearly $1 billion over 10 years. The study also showed significantly lower rates of mortality and better outcomes among patients who had these procedures on an elective basis.…
When it comes to patient safety in the OR, the risk of fire or other damage caused by surgical instruments is an area that deserves greater attention. Professional medical societies concerned about such risks have developed a multidisciplinary curriculum that addresses appropriate and safe use of energy devices in surgery…
Reports about problems associated with power morcellation in gynecologic surgery led to safety warnings in November 2014 by the Food and Drug Administration (FDA) and the Joint Commission. The FDA on November 24 updated its Safety Communication on the use of laparoscopic power morcellation in hysterectomies and myomectomies. The previous…
Protective eyewear is supposed to prevent infectious materials from reaching the eyes of OR staff, but recent research has revealed a link between reusable protective eyewear and an increased risk of cross contamination and infection. “We found that the protective eyewear itself can be a causal factor in ongoing contamination,”…
Children’s Hospital of Los Angeles (CHLA) is renowned for patient care, but by early 2013 the increased complexity of new technology and other factors had eroded efficiency. Orthopedics had fallen to the bottom quartile compared to national benchmarks for turnover times, and executive leadership called for change. Within orthopedic surgery,…