Essential Components for a Patient Safety Strategy

om The safety of operating rooms is dependent in large measure on the professional and regulatory requirements that mandate skill levels, documentation standards, appropriate monitoring, and well-maintained equipment. Prescriptive and detailed protocols exist for almost every procedure performed, and although variation based on surgical and anesthesia preference is allowed, overall there is excellent management of the technical aspects. Experienced operating room physicians, nurses, and technicians come to rely on these operating room characteristics to support the delivery of safe care. Most practitioners, however, at some time—and some much of the time—have had the experience of working in suboptimal operating room conditions because the level of procedural complexity in even the simplest of operative procedures is not matched by the necessary team coordination, leadership engagement, or departmental perspective that encompasses all the prerequisites for reliable delivery of care. There are many causes for this current state that include, depending on country, the mechanisms for reimbursement that impede alignment of interests between physicians and hospitals; the limited interdisciplinary training of the various disciplines—surgery, anesthesia, nursing, and technician—that promote hierarchy and undervalue core team characteristics; and historical perceptions about the roles of physicians, nurses, and ancillary personnel that have not kept pace with the changing nature of care delivery.