Improve communication and prevent retained surgical items
It’s estimated that around 1,500 surgeries each year end with a retained surgical item (RSI). These patients often experience frequent infections, pain, bowel blockage, and other complications—and to add insult to injury, patients then need to be operated on again to remove the RSI.
"The old established view of [RSI cases] 10 years ago was, it's all about nurses counting," says Verna Gibbs, MD, director of NoThing Left Behind®, a surgeon at San Francisco Veterans Affairs Medical Center, and a professor of surgery at the University of California San Francisco Medical Center. "One of the things [NoThing Left Behind] came out of the gates with really early was that it's not just the nurses; it's multi-stakeholder."
Although nurse circulators are typically the ones coordinating what happens in the OR, the surgeons are often seen as the “de facto leaders,” says David Marshall, managing director of Huron and cofounder of MyRounding.
This means physicians need to understand and communicate the importance of everyone in the OR working to prevent RSIs.
“What we see from those organizations that are really moving the needle [in preventing RSIs] is to get physician buy-in to create an interdisciplinary approach,” says Marshall.
For physicians who are resistant to embracing such an attitude, getting a “third leg of the stool”—the governing board—involved can help, says Marshall.
“Surgeons generate 80% of revenue for a hospital. It is like the tail wagging the dog. Administration is often afraid to confront them one-on-one and have the crucial, candid conversations that are needed. That is a hard fact to admit as a hospital,” he says. “But there are those that are starting to say, ‘We have to do something different. I may not be in the best position as the CEO, so we need to find that one person who can come in and be a voice of reason.’ ”