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If I saw both Mark the surgical site and Introduce yourself by name on the list, I would also be suspicious about which items were saving lives and which were w

by mhb 7y ago

If I saw both Mark the surgical site and Introduce yourself by name on the list, I would also be suspicious about which items were saving lives and which were wasting my time. Separately, maybe it would work better to give the checklist to the patient and have her check off the items. In light of some comments, it appears I wasn't clear. My point was that the problem is having BOTH those items on the list. Marking the surgical site is definitely worthwhile. Having it on the same checklist as introducing yourself dilutes the importance of it and the other important items on the list.

TylerE 7y ago
Don't laugh. Mistakes happen, especially with body parts that we have two of, and it's heartbreaking when it does. Amputating the wrong limb, removing the good kidney instead of the bad kidney...
vangelis 7y ago
Consciously marking the surgical site ensures we have the right surgical site. A wrong site surgery 'never event' happens nearly 100 times a year in the US. The introduce yourself by name item is less crucial, but ensures everyone knows who everyone is, especially in larger hospitals. In a stressful environment, it might be the difference between fumbling and not. Apparently it also increases the likelihood that someone will speak up if there is an issue noticed.
tunesmith 7y ago
I recently had a very minor surgery scheduled to have something removed, on the right side. The doctor was filling out the surgery form and checked the "left" box. It was because on the form, the "right" checkbox was on the left side, and the "left" checkbox was on the right. (He immediately caught it and corrected it.)
FabHK 7y ago
Presumably you consider Mark the surgical site to be saving lives, and Introduce yourself by name a waste of time. However, there is a reason for the latter item. There have been many plane crashes in which at least one cockpit crew member had some inkling that something was wrong [1], but their warnings were ignored, often when there was a big authority gap. Crew Resource Management [2] was developed to address this. Introducing yourself by name is designed to emphasise that the group is now a team with a common purpose, and everyone, from the lead surgeon to the nurse, can and should speak up if something looks awry. Quite some thought and research has gone into this. Obviously, this doesn't mean that the ideas can't be criticised, but a facile dismissal like yours is unwarranted and might be one reason the checklists don't live up to their potential. [1] Some examples: The Tenerife disaster, 583 fatalities: 'On hearing this, the KLM flight engineer expressed his concern about the Pan Am not being clear of the runway by asking the pilots in his own cockpit, "Is he not clear, that Pan American?" Veldhuyzen van Zanten emphatically replied "Oh, yes" and continued with the takeoff.' https://en.wikipedia.org/wiki/Tenerife_airport_disaster#Communication_misunderstandings https://en.wikipedia.org/wiki/Tenerife_airport_disaster#Comm... United Flight 172: 'The captain focused on the landing gear problem for an hour, ignoring repeated hints from the first officer and the flight engineer about their dwindling fuel supply. Only when the engines began flaming out did he realize their dire situation.' https://en.wikipedia.org/wiki/United_Airlines_Flight_173 https://en.wikipedia.org/wiki/United_Airlines_Flight_173 Korean Air 801: 'The crew noticed that the aircraft was descending very steeply, and noted several times that the airport "is not in sight." Despite protests from flight engineer Nam that the detected signal was not the glide-slope indicator, Park pressed on.' https://en.wikipedia.org/wiki/Korean_Air_Flight_801#Accident https://en.wikipedia.org/wiki/Korean_Air_Flight_801#Accident [2] https://en.wikipedia.org/wiki/Crew_resource_management https://en.wikipedia.org/wiki/Crew_resource_management
- richardwhiuk 7y ago
  I don't dispute your point, put those seem like examples when someone where someone picked up on a problem and said something, and still nothing was done. Seems doubtful that everyone saying their name would have fixed any of those problems...
  - Baeocystin 7y ago
    One of the core features of crew resource management is that it empowers the crew as a whole with formal methods of communicating with people that rank above or below them in a way that (ideally) sidesteps the ego problem.
    - endgame 7y ago
      Interesting that this article on graded assertiveness begins by using the formal title of the person being queried: https://gcaptain.com/graded-assertiveness-captain-i-have-a-concern/ https://gcaptain.com/graded-assertiveness-captain-i-have-a-c...
jcwayne 7y ago
"Hey there Mr. Smith, I'm Dr. Brown. I'm going to be doing blah, blah, medical stuff, right here on your left abdomen." ... "Well that's the right spot doc, but I'm Mr. Jones."
- deleted 7y ago
  [deleted]
- walshemj 7y ago
  Interesting in the UK your continuously responding with your name and hospital number maybe there is more turnover in the US system. Though I am a long term patient with a chronic condition so that might make a difference.

by mhb 7y ago

TylerE 7y ago

Don't laugh. Mistakes happen, especially with body parts that we have two of, and it's heartbreaking when it does. Amputating the wrong limb, removing the good kidney instead of the bad kidney...

vangelis 7y ago

Consciously marking the surgical site ensures we have the right surgical site. A wrong site surgery 'never event' happens nearly 100 times a year in the US. The introduce yourself by name item is less crucial, but ensures everyone knows who everyone is, especially in larger hospitals. In a stressful environment, it might be the difference between fumbling and not. Apparently it also increases the likelihood that someone will speak up if there is an issue noticed.

tunesmith 7y ago

I recently had a very minor surgery scheduled to have something removed, on the right side. The doctor was filling out the surgery form and checked the "left" box. It was because on the form, the "right" checkbox was on the left side, and the "left" checkbox was on the right. (He immediately caught it and corrected it.)

FabHK 7y ago

Presumably you consider Mark the surgical site to be saving lives, and Introduce yourself by name a waste of time. However, there is a reason for the latter item. There have been many plane crashes in which at least one cockpit crew member had some inkling that something was wrong [1], but their warnings were ignored, often when there was a big authority gap. Crew Resource Management [2] was developed to address this. Introducing yourself by name is designed to emphasise that the group is now a team with a common purpose, and everyone, from the lead surgeon to the nurse, can and should speak up if something looks awry. Quite some thought and research has gone into this. Obviously, this doesn't mean that the ideas can't be criticised, but a facile dismissal like yours is unwarranted and might be one reason the checklists don't live up to their potential. [1] Some examples: The Tenerife disaster, 583 fatalities: 'On hearing this, the KLM flight engineer expressed his concern about the Pan Am not being clear of the runway by asking the pilots in his own cockpit, "Is he not clear, that Pan American?" Veldhuyzen van Zanten emphatically replied "Oh, yes" and continued with the takeoff.' https://en.wikipedia.org/wiki/Tenerife_airport_disaster#Communication_misunderstandings https://en.wikipedia.org/wiki/Tenerife_airport_disaster#Comm... United Flight 172: 'The captain focused on the landing gear problem for an hour, ignoring repeated hints from the first officer and the flight engineer about their dwindling fuel supply. Only when the engines began flaming out did he realize their dire situation.' https://en.wikipedia.org/wiki/United_Airlines_Flight_173 https://en.wikipedia.org/wiki/United_Airlines_Flight_173 Korean Air 801: 'The crew noticed that the aircraft was descending very steeply, and noted several times that the airport "is not in sight." Despite protests from flight engineer Nam that the detected signal was not the glide-slope indicator, Park pressed on.' https://en.wikipedia.org/wiki/Korean_Air_Flight_801#Accident https://en.wikipedia.org/wiki/Korean_Air_Flight_801#Accident [2] https://en.wikipedia.org/wiki/Crew_resource_management https://en.wikipedia.org/wiki/Crew_resource_management

richardwhiuk 7y ago
I don't dispute your point, put those seem like examples when someone where someone picked up on a problem and said something, and still nothing was done. Seems doubtful that everyone saying their name would have fixed any of those problems...
- Baeocystin 7y ago
  One of the core features of crew resource management is that it empowers the crew as a whole with formal methods of communicating with people that rank above or below them in a way that (ideally) sidesteps the ego problem.
  - endgame 7y ago
    Interesting that this article on graded assertiveness begins by using the formal title of the person being queried: https://gcaptain.com/graded-assertiveness-captain-i-have-a-concern/ https://gcaptain.com/graded-assertiveness-captain-i-have-a-c...

jcwayne 7y ago

"Hey there Mr. Smith, I'm Dr. Brown. I'm going to be doing blah, blah, medical stuff, right here on your left abdomen." ... "Well that's the right spot doc, but I'm Mr. Jones."

deleted 7y ago
[deleted]
walshemj 7y ago
Interesting in the UK your continuously responding with your name and hospital number maybe there is more turnover in the US system. Though I am a long term patient with a chronic condition so that might make a difference.