Standard "time out" alone not always enough to prevent surgical errors

Regarding "Hospitals shine light on mistakes by publicly saying: 'We're sorry' " (Article, Aug. 11): Although the issue of public disclosure of medical errors is certainly important, it occurred to me that exploring how to prevent future similar errors is a more important issue. The concept of "time out" prior to starting an operation sounds good, but did not successfully prevent the removal of the wrong kidney in the case mentioned in the article.

Since the recent promotion of time out, I have been concerned that this process may not adequately prevent errors. I participate in several time outs every week. Most of these only confirm that the procedure being started and the patient in the room are in agreement with the procedure and patient listed on the operating room schedule.

What if the secretary preparing the schedule copied information incorrectly, or heard wrong information from the scheduler in the doctor's office? The time-out process would not discover this. The time out merely announces the scheduled procedure, the patient's name, and the surgeon.

Certainly, we should not rely on the surgeon's memory to confirm that everything is correct on the surgery schedule. Last Wednesday, I did 10 cataract surgeries. I would never expect myself to remember which eye and which intraocular lens was scheduled for each patient.

Because of this, to confirm the correct procedure, patient, and intraocular lens (in this case, for cataract surgery), I always bring each patient's office chart, including the original intraocular lens calculation sheet, with me to the surgery center or hospital. I use it, not the surgery schedule, to confirm the procedure, the patient and the appropriate intraocular lens. The main benefit to this approach is that it avoids any copy errors.

Some surgeons have suggested "cheat sheets," with a list of patients, procedures and intraocular lenses. To my way of thinking, this is a process wide open for copy errors, even if the surgeon personally prepares the sheet. My approach checks back to the original document in each case, rather than depending on anything that could have been copied incorrectly. If there is an imaging study, or other objective information, this should be in the room and confirmed before starting the case.

Marshall C. Wareham, MD, Dayton, Ohio

Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/09/15/edlt0915.htm.