It’s not a shock that surgery on the heart and pericardium logs the highest rate of adverse events (556.7 events out of every 1,000, according to Patient Safety in Surgery study of over 80,000 surgical hospitalizations) — but what may be most surprising is that majority of the top factors influencing patient safety are not technological or circumstantial… they’re interpersonal.
While that may seem hard to believe, the research is clear about what’s disrupting surgical flow and affecting patient outcomes. Adverse events can’t be eliminated, but they can be reduced. While circumstantial components such as case history or condition can’t necessarily be controlled, these safety factors can be addressed before the first incision, creating the best possible chance for improved outcomes.
The Top 5 Factors that Impact Patient Safety in the OR
According to Circulation, a publication of the American Heart Association Journals, and Patient Safety in Anesthesia, the top 5 factors that impact patient safety in the cardiac OR are as follows:
- Communication
- Collaboration
- Physical Environment
- Disruptions
- Deficits in Safety Culture
Even as technology has evolved, team alignment and the logistics of the physical environment still play a major role in the balance of risk and safety in the cardiac OR.
#1 – Communication
The greatest factor for improving safety in the cardiac OR is communication between surgeons and support staff. Circulation states that “iscommunication has been implicated as the root cause of error and adverse outcomes in both general and cardiac surgery.” It also reports that 65% of sentinel events reported by The Joint Commission between 2004 and 2012 played a role in errors related to care as well as operative and post-operative events. Additionally, Patient Safety in Anesthesia reports that 87% of cases that resulted in an indemnity payment were due to communication problems.
#2 – Collaboration
Collaboration is another teamwork element that can cause serious issues in the cardiac OR. Circulation states that breakdowns in teamwork occur at a rate of 17 per hour, according to one study; another reported 11 per hour. This is significant, given that a patient’s outcome can be affected by even one collaboration problem. Teams that take a proactive approach to collaboration will increase their efficiency, camaraderie, and patient safety in the OR.
#3 – Physical Environment
Another underrecognized factor influencing patient safety in the cardiac OR is the actual physical environment. Circulation states, “Poor OR ergonomics are present in many, if not most, cardiac ORs. Hazards for both patients and staff exist, including infection in patients related to personnel traffic and airflow, risk of injury to staff caused by tripping over cords and equipment, and hazardous noise levels for everyone in the room because of alarms, music, and multiple simultaneous conversations.” If just 15 or 20 minutes are taken to assess the room, align with team members, and improve workflow within the space, physical environment issues can be significantly reduced.
#4 – Disruptions
Disruptions play a significant role in the OR, where maintaining optimal focus is key to a patient’s outcome and recovery. Unfortunately, Patient Safety in Anesthesia reports that “disruptions in surgical flow occur on average 11 times per cardiac surgical case and are associated with technical errors.” Equipment should be regularly assessed and staff should be taught to aggressively reduce disruptions. Team briefings and the intentional teaching of nontechnical skills — to all staff, including surgeons — can cut down on the number of disruptions that may alter patient outcomes in the cardiac OR.
#5 – Deficits in Safety Culture
In a review of literature, Anesthesia & Analgesia found that in cardiac surgery, “minor events were predictive of major problems: multiple, often minor, deviations from normal procedures caused a cascade effect, resulting in major distractions that ultimately led to major events.” Reducing these minor events involves tracking, reporting, correction, and alignment. Safety culture allows these events to be identified and escalated for improvement in a routine way that does not isolate or shame team members. Without a safety culture, events often go unreported to avoid friction or tension.
For a more in-depth analysis of these factors and how to address them, download our free guide here.
How SpecialtyCare Can Help Improve Safety in the OR
At SpecialtyCare, it’s our mission to help make surgery safer, and we partner with ORs around the nation to provide critical services, reduce errors, and optimize team performance. As the industry leader in OR services, our teams are integrated with 1,200 hospitals and health systems nationwide, supporting 13,500 physicians during 500,000+ procedures annually.
We are highly experienced, among the most trusted leaders in the cardiac industry. We hire and train some of the best specialists in the medical industry to entrench ourselves as the source of reliable coverage for some of the most complex operations in modern medicine. If you’re interested in how we can assist you in improving processes and outcomes in the cardiac OR, contact us today!
