Background
Medical errors are inherently of great concern in modern health care. Approximately 1-in-10 hospital in-patients experience an adverse event, and nearly two-thirds of these are associated with a surgical provider. Adverse events in surgical patients are estimated to be highly preventable in 48% of the cases. Although incorrect surgery—defined as wrong patient, wrong site, or wrong procedure—occurs infrequently, surgical teams recognise these as devastating events to experience. A case review of wrong-site craniotomies identified five major contributing factors: communication breakdowns, inadequate preoperative checks, technical factors and imaging misidentifications, and simple human errors. A near-miss event study of orthopaedic procedures and noncompliance to antimicrobial prophylaxis identified causes as human, organisational, and material factors. Systematic use of a checklist prior to incision as a preventive effort was recommended by 40% of the declarants, along with improved communication between anaesthetists and surgeons. In a malpractice claim study in the Netherlands, wrong patient, wrong site, or wrong procedure were identified in 16% (46/294) of cases and were suggested to be preventable if the staff had followed the comprehensive Surgical Patient Safety System (SURPASS) of checklists. Ensuring the correct patient, correct site, and correct procedure is vital in order to avoid incorrect surgery. The Joint Commission (JC), an independent organisation accrediting and certifying health care organisations in the United States, underlines the importance of implementing a range of risk reduction strategies to prevent wrong-site surgery. Amongst these recommendations is that the surgical team should take a time-out and use active communication techniques to verify they are dealing with the correct patient, site, and procedure.
Several studies show reductions in both mortality and morbidity after introducing surgical checklists. Improved communication and shared responsibility within the health care teams may contribute to the elimination of wrong-site surgery. As error management depends on human skills and reliability of surgical team members, a systematic approach is required.
In a concurrent safety climate study performed at our hospital (Haukeland University Hospital) prior to the introduction of surgical checklists, anaesthetic personnel scored significantly higher than operating room nurses and surgeons on frequency of near-miss events reported. In general, the safety climate perceptions were significantly underscored when compared with hospital staff in the U.S., e.g. 31% to 62% on frequency of near-miss events reported. Report of near-miss perceptions is considered to have several advantages as fewer barriers, limited liability and patterns which could be captured and used to improve surgical care. To better understand the nature of near misses in surgery, a deeper understanding of surgical team members' perceptions and attitudes has been warranted.
We investigated surgical team members' perceptions of incorrect surgery and how the correct patient, correct site, and correct procedure were ensured in daily routines. We hypothesised that perceptions of near-miss experiences and attitudes towards Time Out protocols vary widely amongst surgical team members.