Patient Safety in Surgical Care: A Systems Approach

Abstract

June 2007

Section Elements of Contemporary Practice

5 Patient Safety in Surgical Care: A Systems Approach

Robert S. Rhodes, M.D., F.A.C.S.
Adjunct Professor of Surgery, University of Pennsylvania School of Medicine, and Associate Executive Director and Director of Evaluation, American Board of Surgery, Philadelphia

It is difficult to estimate the number of error-related medical injuries with precision, and even conservative estimates of error frequency far exceed the rate of more publicized nonmedical disasters. These lower estimates would not be tolerated in nonmedical settings and should not be tolerated in patient care. This chapter evaluates current information on patient safety and the quality of surgical care in the context of system failure. The shortcomings of existing quality-improvement measurements are discussed, and the idea of patient care as a system is introduced, with examples of successful quality improvement systems that have already been implemented. Safety-improvement techniques derived from nonmedical systems can be also applied to medical systems, and examples of these are given. Current obstacles to quality improvement are many and include a traditional medical culture based on individual responsibility and blame, vulnerability to legal discovery and liability, and primitive medical information systems. Ways in which surgeons can take the lead in overcoming these obstacles are discussed. This chapter contains 182 references.

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