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Risk Management Matters, Especially in the Operating Room

By Diane Doherty, MS, CPHRM

Let’s talk about Operating Room (OR) safety. We all know that operating rooms can be dangerous places as harm to both patients and staff can occur in many different ways. While healthcare professionals consistently strive to provide quality care and reduce errors, there will always be an inherent measure of risk. This is especially true in busy operating rooms where distractions and interruptions can lead to serious errors or omissions in a matter of seconds.

The list of variables in the surgical process that are susceptible to error is long—from patient identification and surgical site validation to instrument counts, patient handoffs and discharge readiness. It takes a combined team effort of the surgeon, anesthesiologist, nurses and technicians to operate in a safety-conscious environment.

Effective management in the operating room is critical and requires the specialized intervention of a healthcare risk manager. Risk managers are deft at examining clinical process, observing workflows, suggesting ways to integrate risk mitigation best practices and conducting ongoing assessments to identify areas needing improvement. Here’s how risk managers can leverage proactive and strategic actions to help surgical teams ensure maximum patient safety.

Risk assessment

Risk managers are the experts with examining risks in the clinical settings and working with medical staff to reduce exposures together. In the surgical setting, the process starts with reviewing written policies and procedures, observing staff in their day-to-day roles and looking for signs of a culture that promotes safety, respect and accountability.

Patient selection

The most important question to ask in a surgical setting is if the patient is an appropriate candidate for the selected procedure. Risk managers can minimize surgical liability exposures by ensuring that comprehensive patient selection criteria is put in place and adhered to by physicians and surgical staff. Without a thorough patient selection procedure, the benefits of a particular surgery may be open to speculation.

Informed consent

After confirming a patient is suitable for surgery, it is essential that detailed information about the procedure is shared with the patient. Risk managers must play an important role in educating staff about the importance of informed consent including the benefits of a pre-procedure verification process that ensures all relevant information is conveyed to the patient and documented in their healthcare record.

Safety functions

Safety processes to help mitigate errors in high-risk industries have evolved to include everything from aviation to, now, healthcare. To ingrain those processes in their own organizations, risk managers should use standardized safety checklists that are designed to help hospital staff spot and resolve problems during all three stages of surgery—pre-anesthesia, pre-skin incision and ahead of patient handoff. At key junctures in the surgical process, checklists streamline communication on various high-risk issues, including anesthesia safety, equipment readiness, known allergies, bodily positioning and surgical counts.

Patient handoffs

Standardized handoff protocols facilitate the accurate transmission of information about a patient’s care and condition whenever changes occur in surgical personnel. By encouraging the use of handoff templates that promote communication and documentation in a structured, thorough and unhurried manner, risk managers can enhance team communication and can help reduce errors in information transfer.

Conflict management

In spite of communication safeguards, some level of interpersonal friction is inevitable in a surgical setting. If left unattended, conflict can negatively impact teamwork and patient safety. Granted, stress levels do run high in an operating room, but when conflicts develop, risk managers should encourage open communication and respectful dialogue and mediate using conflict resolution principles.

Discharge readiness

With in-patient stays on the decline, hospitals are retooling their discharge planning processes with an eye toward post-discharge care directive adherence. To help bolster this effort, risk managers should help develop post-hospital care plan templates and monitor post-discharge communication with patients and loved ones.

Implementing these risk management recommendations can assist risk managers with identifying areas of actual and potential loss exposure and highlights those areas that may need to be strengthened to ensure patient safety in the surgical setting.

The material presented in this article is not intended to provide legal or other expert advice as to any of the subjects mentioned, but rather is presented for general information only. You should consult knowledgeable legal counsel or other knowledgeable experts as to any legal or technical questions you may have.

Chubb is the world's largest publicly traded property and casualty insurance company, and the largest commercial insurer in the United States. With operations in 54 countries and territories, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. For more than 25 years, healthcare organizations have relied on Chubb for insurance products and services that provide an effective insurance program for managing their risk. The company has a broad appetite, and serves a wide range of organizations—from an assisted living facility to an urgent care center to a nationally recognized children’s hospital.