• The changes are designed to prevent errors
such as the one that occurred in December at Rhode Island Hospital, where a doctor operated on the wrong side of a man's head.
Journal Staff Writer
PROVIDENCE
-- Aiming to prevent surgical errors, the Lifespan hospital network is imposing new safety measures, from checking patients' identities repeatedly, to marking the site of their surgery with a pen.
Public concern about operating-room mistakes has put pressure on medical institutions across the nation in recent years, and Lifespan, the parent company of Rhode Island Hospital, has faced its share of criticism.
Last December, a doctor there operated on the wrong side of a man's head. And in 2000, a girl who was supposed to get eye surgery got a tonsillectomy after being mistaken for another child.
Neither patient was seriously harmed, the hospital has said. But coincidentally, just days earlier, a national trade group, the Joint Commission on Accreditation of Health Care Organizations, had issued an alert urging hospitals to take more precautions. The hospital has been working on adopting them for two months.
The group recommended five measures:
• Mark the surgical site with a permanent-ink pen, when appropriate.
• Have each member of the surgical team orally verify the surgery, inside and outside the operating room, to ensure they have the right patient, surgical site, and procedure.
• Create and use a "verification checklist," including the oral checks as well as documents such as x-rays and medical records to be looked at before operating on a patient.
• Take a "time out" in the operating room before starting.
• Monitor compliance with these procedures.
Yesterday, Lifespan president and CEO George Vecchione said the entire network is adopting the recommendations, hoping to make its hospitals "among the safest in the nation."
Along with Rhode Island Hospital, the Lifespan network includes Hasbro Children's Hospital, Miriam Hospital, Newport Hospital, and Tufts-New England Medical Center and its Floating Hospital for Children.
But the focus of recent scrutiny has been Rhode Island Hospital, and Vecchione was joined in his announcement by Dr. Joseph Amaral, president of the hospital, where the policies are to be in place by March 20.
Amaral said surgery is "a very complex event," and there are always "latent conditions" that can cause errors -- all it takes is to mishear a word, or mix up two similar names.
The medical staff are "highly skilled, very dedicated people," but they are fallible, like all human beings. So the key, Amaral said, is to have "a series of steps" in the surgical process to catch mistakes. You don't check the patient's name once, but multiple times, in case someone else didn't get it right. Just in case, you check again before you make an incision.
Communication is crucial, Amaral and Vecchione said -- structured communication, with specific questions, and lots of repetition.
The hospitals will closely monitor compliance, Amaral said, so if there is an error, it can be traced. But that doesn't mean that doctors will be penalized for skipping a step, he said: if a gunshot victim has a big wound on his chest, who needs to draw an "X" on the surgical site?
And the new policies are not being implemented in a vacuum, but rather will build on existing practices at the hospitals.
Rhode Island Hospital was already orally confirming patient identity and surgical site, for example -- that was implemented after the tonsillectomy mistake, though the brain-surgery error still slipped through.
By late this month, the hospital also plans to have new patient bracelets that will include a photo and a barcode that medical staff can scan. The system may eventually be adopted by other Lifespan hospitals, Amaral said.
And throughout the network, a computer system called "Lifelinks" now gives doctors instant access to patients' medical records -- including lab-test results, allergy information, and a list of the drugs they are taking.
The next step, Amaral said, is a system that will allow doctors to send prescriptions directly to the pharmacies by entering them on their computers, eliminating the potential for handwritten prescriptions to be misread. The system will also alert physicians to dosage problems, known allergies, and potential drug interactions.
Both Vecchione and Amaral pointed to all the hospitals' efforts as evidence that safety is their "number-one priority." Media reports of mistakes have made people afraid, Amaral said, and they shouldn't be.
"It's important for people not to think that hospitals aren't safe," Amaral said. "Hospitals
are
safe."
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