Timeouts, risk assessments and more: the non-negotiable patient safety rules for spine surgeons

Written by Anuja Vaidya | June 20, 2019 | Print  | Email

Three spine surgeons discuss the precautions they take to ensure patient safety before, during and after surgery.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What is the next big health IT innovation you expect to see?

Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, June 26, 5 p.m. CST.

Note: The following responses were edited for length and clarity.

Question: What are some of your non-negotiable patient safety rules?

Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Patient safety is obviously the most important concern when performing spine surgery. A lot of leg work to ensure the surgery is done safely is done preoperatively. First off, the patients need to be healthy enough to tolerate the surgery and the general anesthesia. The extent of medical clearance depends on a patient's age and health status. For elective surgery, until the patient is cleared, the surgery will not happen. For most instrumented procedures, I also arrange for intraoperative neuromonitoring, which has helped me to avoid complications and nerve damage on multiple occasions.

Intraoperatively, one of my biggest concerns is infection prevention. For the most part, infection rates for elective spine surgery are very low, but it takes the effort of multiple people inside and outside of the operating room to avoid instrument and wound contamination as much as possible. I educate the OR staff, anesthesia and sterile processing departments about the techniques and importance of maintaining proper sterility. On the other hand, if on the day of surgery, the patient presents with open sores, rashes or any kind of infection or poorly controlled blood glucose, the surgery will be postponed so that the patient can be optimized.

After the surgery is complete, I work with the patient's nurses and physical therapists to make sure they know proper protocols for wound care and mobilization to prevent falls, wound complications, and to ensure quick return to full activity.

Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): All aspects of patient safety are the priorities in my practice. It starts at the minute I see them in the office to discuss surgical options. I identify their risks from detailed history such as their BMI, their co-morbidities, anticoagulation medications, smoking and drinking habits, known complications from previous surgeries, etc. I will do everything in my power to reduce their risks unless it is an emergency situation. For example, I have cutoff BMI for my surgical patients. I rarely perform fusion if they are active smokers.

In the OR, the timeout is crucial and non-negotiable; therefore, we are very serious and pay attention during the timeout. The sterility in the OR and maintaining aseptic technique are also non-negotiable for patient safety.

I always encourage my staff to speak out, and everyone is empowered and expected to stop and question when things just don't seem right.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: It begins the night before the case, where I look at the patient films. I verify all the details of the operation, notable anatomical 'landmarks,' as well as the patient's chief complaint. In the preoperative stage, the patient and I do our own timeout, verifying which part of their body is hurting and which area we will be operating on. I also use that time to see if they have any last-minute questions. An informed patient is a satisfied patient.

In the OR, proper positioning is probably the first rule. The films are always pulled up on the PC or laptop. The levels are all clearly labeled on the imaging software. An uninterrupted surgical timeout is critical before anything is done to the patient after the prep and drape is done. Sharp and clear fluoroscopic images are a must. Lastly, we all debrief as closure is started, verifying the intended procedure and so forth.

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