Quality Assurance is More than a Talking Point, It’s Our Duty

UCH is #1 for patient safety in the nation!

doctor on phone with patientAs a doctor and 13-year member of the quality assurance program at University of Colorado Hospital (UCH), I take great pride in continued recognition as one of the safest hospitals in the United States.

I currently serve as Vice Chair of Quality and Clinical Effectiveness, a position I have held for the department of OB-GYN since 2001. As such, my responsibility is to ensure our specialty institutionalizes safety across all facets of the hospital and for all patients.

In agreement with the American Congress of Obstetricians and Gynecologists, a major initiative has also been to ensure safety in outpatient settings. I’m proud to be part of this movement for my hospital.

As part of the University HealthSystem Consortium (UHC) – an alliance of 118 academic medical centers representing the nation’s leading academic medical centers – UCH received the number one spot for patient safety in 2011 and 2012.

Additionally, UCH was ranked in 2013 by U.S. News and World Report as the top hospital in Colorado. As part of the recognition, which takes into account “success in keeping patients safe,” gynecology at UCH was ranked as top performing in the state.

While the accolades are in themselves noteworthy, more importantly they are the product of years of concerted planning to guarantee our patients consistency in preventive, acute and chronic services.

For me and my fellow physicians, quality assurance and patient safety at UCH are not merely talking points. It takes a genuine effort to guarantee the delivery of quality health care. Nowhere is this more apparent than in the operating room.

Surgical Checklist

To many of our patients, surgical checklists seem like they should be commonplace in operating rooms across America. Unfortunately, they are not.

Our principal focus in having our checklist is to reduce accidents and medical mistakes.

UCH’s surgical checklist:

  1. Quiet in the operating room to bring together and introduce each member of the anesthesia, surgical and nursing teams.
  2. Recognize the patient through multiple identifiers.
  3. Antibiotic and allergy lists to identify that the patient has received preoperative antibiotics prior to the surgical incision if needed, and review of allergies to ensure no allergens are planned to be used during the procedure.
  4. Position management ensures that the patient is in the correct position for the planned surgery with no undue stretch which could result in discomfort or pain following the surgery.
  5. Patient consent to ensure that the consented surgery is the planned surgery.

Each individual working in the OR understands his or her role during the procedure. Empowering the whole crew – no matter their title or position – to speak up if something looks awry is reinforced.

Scratching the cookbook

As part of medical quality assurance, it’s necessary to recognize that no two patients are the same and our treatment considerations need to reflect that. Therefore we use patient care pathways, which requires a focus on variability in care.

Rather than relying on “cookbook medicine” to standardize our course of action, we focus on medical variance and use evidence-based therapies to manage disease and health. Mapping out our steps also ensures we are more efficient with our time in the OR and between interventions.

Communication is key: what did we do and what can we do better?

Setting aside a time prior to leaving the operating room to pull the team together to discuss the procedure is an important last step in quality assurance and patient safety. It provides us a comprehensive overview to identifying any events that may require altering systematic issues. It will allow us for better training and prepare us for future operations.

Such questions include: What could be done better the next time?  Are there any concerns for the patient in the post op setting which are unique to the patient?  Were all the surgical equipment/tools available?  Are the pathology specimens ready to be sent for pathologic evaluation with correct labeling?

This debriefing session also allows us to focus on better crew resource management. Much in the same way of the preoperative stage, we are empowering every participant in the surgery to provide input on systematic changes.

Historically, staff in operating rooms were plagued by the same hierarchical restraints presented in an airplane cockpit. As one recent study on operating room safety noted, both airline operators and medical professionals face significant on-time pressures, high workloads, dependence on properly working equipment, a rigid hierarchy and a potential for catastrophic results if errors occur. Through our quality assurance program, we ensure we are not prone to the same pressures.

Effective communications is crucial. There is a lot going on during an operation and it’s our goal empower a technician to point out a potential red flag to a surgeon before an error occurs.

University of Colorado Urogynecology is a specialty women’s health practice focused on female pelvic health and surgery. Our physicians are also professors & researchers for the CU School of Medicine, one of the top-ranked medical schools in the nation.

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