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Boston Medical Center 2014 Recognition, management, and prevention of specific operating room catastrophes Presented at the American College of Surgeons 89th Annual Clinical Congress, Chicago, IL, October 2003. Christopher R. McHenry MD, Ramon Berguer MD, FACS, Rafael A. Ortega MD Journal of the American College of Surgeons Volume 198, Issue 5 , May 2004, Pages 810-821 WHO Checklist: 24 Boxes OR Trauma/Spine Plasma Screen Pre-op Holding Area Pre-op Holding Area Difficult Intubation Cricoid Pressure Sensor Difficult Airway Predictor Anesthesia Touch OR Scenario Mandated attendance 2 entire OR teams Delayed start of OR in 2 rooms (9:30 AM) Fire/bleed Robust debriefing 2 sessions/month NO EXCEPTION Leap Frog Recognition for BMC Obstetrical Article Simulation Embedded in BMC’s Culture * * * * * * * * * * * * Note that if time allows, there is a vignette and series of discussion questions about barriers to communication in the instructor manual. * * * * * * * * * * * * * * Assess COMPLEXITY Before Your Proceed Know Risk Factors Multiple Surgeons Present BMI 40 Rapid Closure/Changed Procedure Procedure Done Different from Original Plan Multiple Team Changes NEJM 2003;348:229-35 Add Levels of PREPAREDNESS Part of Universal Protocol Mandate X-ray for High Risk Procedures Manual/Visual Inspection of the Cavity Notification of Location on Field Retained Foreign Body Alert Train and Educate the Radiologist Avoid CUTTING pledgets Wrong Site Surgery Wrong Site Surgery Incidence: 1/112,000 Per year in a 300 bed hospital Wrong-side arthroscopy: $450,000 Wrong cervical disc: $1,175,000 Its PREVENTABLE National Quality Forum – Never Event Joint Commission – Sentinel Event Ann Surg 2007;246:395-405 Joint Commission’s Evaluation of 126 Cases Orthopedic 41% General Surgery 20% Maxillofacial, CV, 14% Oto, Ophthalmology Urology 11% All Others 14% Ambulatory (58%), Inpt OR (29%),