Rev. bras. ortop. vol.49 número6

(1)

r e v b r a s o r t o p . 2014;49(6):553–554

w w w . r b o . o r g . b r

Editorial

Safe

surgery

for

all

夽

Cirurgia

segura

para

todos

Thesurgical act involves risks and responsibilities for the patient,thesurgeonandthehospitalatdifferentdegreesof intensity.

Aninterestingpracticeknownas“timeout”,formingpart ofthe SafeSurgery project, hasbeen disseminated among hospitals.

Theideais tocheckall the possibilitiesfor failurethat mightoccurduringthesurgicalprocedureandfailuresdueto mistakesatdifferentlevelsofsharedresponsibilitybetween thehospital,physicianandmembersofthepatient’sfamily, inthecaseofdependentindividuals.

Checkingallthestepsofaprocedureisahabitthatwas bornthroughaviation.Oneofthebestairplanesofthe Sec-ondWorldWar,theB-17cargoplane,crashedsoonafterits firsttake-off,eventhoughaveryexperiencedpilotwasflying it.Onanalyzingwhathadhappened,Boeingfoundthatthe pilothadnotconfiguredtheplanebeforetakingoff.Fromthen on,achecklistprocedurebecamemandatorywithinaviation (source:TheChecklistManifesto,byAtulGawande).

Withinsurgery,thecheckingprocedureisperformedbyan employeeofthesurgicalcenter,whoasksthesurgeon(the personwho isconsideredtohold thesole responsibilityof thesurgicalact)toconfirmthepatient’sidentity,thesideto beoperated,theimplantmaterialtobeused,theanesthesia thatwillbeadministered,thesterilizationoftheinstruments and,finally,whethertherewillbebleedingandwhatthelikely durationoftheoperationwillbe.

Themajorityofthepreparatorystepstakeplace indepen-dentlyofthesurgeon’saction.

Thus:

1 Thepatientisbroughtintotheoperatingtheaterwiththe limbtobeoperatedalreadypreparedintheward.Therefore, thesurgeonneedstodouble-checktheworkdonebythe nursingteamandcheckthesidetobeoperatedfromthe notes,becausethepatientwillgenerallyalreadybeunder

夽

Pleasecitethisarticleas:CamanhoGL.Cirurgiaseguraparatodos.RevBrasOrtop.2014;49:553–554.

sedation.Thesurgeonshouldalsocheckthequalityofthe preparation.

2 Thesterilizationoftheimplantmaterialdoesnotdependon thesurgeonbut,rather,onthesupplier,inthecaseof con-signedmaterial,oronthehospital,inthecaseofsupplied material.

3 Thetypeofimplantmaterialthatismadeavailableis,in somecases,dependentonauthorizationfromthehealth insurancecompany.

4 Theanesthetictechniqueischosenbytheanesthetist. 5 Althoughchemicalindicatorsexist,thesterilizationofthe

instrumentsisdonebythehospitalandthereisnowayof checkingthis.

6 Thedurationoftheoperationandbleedingcanperhapsbe minimized.Thesearenotobjectivesofthesurgicalact,but consequencesofasetoffactors.Thematerialavailablefor carryingoutthesurgicalactisdirectlyproportionaltothe durationoftheoperation.

Althoughthisisaninterestingpracticeandonethat with-out doubt increases the safety of the operation, after this checklist(ortimeout,asitisknowninmedicalcircles)has beenconducted,thesurgeontakesontheresponsibilityfor alltheconditionsrequiredfortheoperation.

Thislast pointis sometimesforgottenbut,just like the pilot,oncetheassessmenthasbeenapproved,theonly per-sonresponsibleforwhatmightoccurduringtheoperationis thesurgeon.

Duringthejourney,theaviatordescribeseverythingthat heconsiderstobeofrelevanceand,attheendofthejourney, writesanextensivereportnotingwhathappenedduringthe flight,thusproducingadocumentthatwillbeusefulfor cor-rectingproblemsthatmayhaveoccurredandwhichmightbe repeated.

(2)

554

rev bras ortop.2 0 1 4;49(6):553–554

with patient preparation and going to the quality of the material and the nursing care provided in the operating theater.

Inthismanner,wewouldbeendingthedistributionofall thelevelsofresponsibilitythatarecreatedbythechecklistand returningtheresponsibilityforeventsthatoccurred during theoperationandwhichwereindependentofthesurgeon’s actions,tothehospital.

Thisinformationcycle,whichbeginswithidentifyingand analyzingtheinitialscenarioofthesurgicalenvironmentand endswiththesurgeon’s report,isanimportantcomponent thatwillaidinimprovingtheteaminvolvedinthesurgery and indefending the surgeon in casesofpossible accusa-tions.

Thedescriptionofthesurgeryisourblackbox:weneedto takegoodcareofitsqualityandinmaintainingit.

In this way, we improve the possibility of having safe surgeryforallthoseinvolvedintheoperation.

GilbertoLuisCamanho RevistaBrasileiradeOrtopedia E-mail:[email protected]

Availableonline25October2014