Quality improvement processes for patient safety in operating room

Abstract

Background : Due to the fact that many risk factors causing complications in surgical patients are related to the processes of patient care. Most surgeons are afraid of any form of complication in their patients and do their best to prevent any risk that may be related either to surgical diseases or surgical treatments. Nevertheless, complications do occur; most of them are specifically related to surgical diseases, It is also important to analyze the processes of care in an effort to decrease complications related to the treatment of the diseases. It is these processes of care that are being increasingly recognized as the etiology for medical errors.

Methods : From January 2002 – December 2007, all surgical patients were operated by the operating room services of the Department of Surgery, Bangkok Metropolitan Administration Medical College and Vajira Hospital. The following data were the time intervals to the start of emergency operations, rate of cancellation of operations, rate of repeated operations in single admissions cases, rate of death among operated patients, foreign bodies or instruments retained either in the wound or body of the patients, surgical site infections, operations on the wrong patients/ wrong sites/using of wrong procedure, incidence of surgical fire as well as the number of patient operations where accidents were recorded, The data were analyzed and the processes of quality management were improved for patient safety.

Results : The time interval to the start of an emergency operation was significantly within The target range from 2002 – 2005 (p <0.05). The death rate for operated patients was not significant during the initial process. After the root causes were analyzed and quality improvement processes were completed the death rate significantly decreased after 2004 (p = 0.01). Also the rate of operation cancelations has decreased and the result has been significantly within the target range since 2003 (p < 0.05). The rate of repeated operations was well correlated with preoperative preparations and the death rate of operated patients. The results of prevention of any foreign body being retained either in the wound or body of the patient were not significantly controlled but incidences of any surgical fire, operations on the wrong patient and incidences of the patients having accidents never occurred. The surgical site infections were significantly within the target range (p <0.05)

Conclusions : Improvements in the processes of care in the operating room can decrease complications related to treatments and improve patient safety.