By George Edwards, Jr, MD

In our ever-advancing digitized world it is convenient to take call and perform consults using cell phone images of wounds and X-rays, to dictate and sign charts remotely by phone, check patient records by computer, etc, etc.  There are no more beepers, answering services, hospital medical record rooms, lost X-rays or charts, or illegible orders.

But what about preventing mistakes in the OR?

Studies indicate that wrong site surgery, or the wrong procedure in the correct site or forgetting to perform all of the scheduled procedures is as common now as in the past.  “Sign the site” and “Time-outs” are definitely helpful, but I have been aware of cases in the last year involving surgery performed on the wrong side (knee scope) and wrong procedure in the correct hand (CTR instead of trigger thumb release with pre-op initials ambiguously on the thenar eminence), both with proper “Time Outs!”  Have we forgotten how to focus, really listen and perform the communicated procedure we just heard 10 seconds ago?

Since none of our short term memories are improving over time, our surgery center has instituted two things to help prevent such errors:

• A dry marker board with the patient’s name and procedure(s)…written by the circulating nurse.  This is not only useful for remembering the procedure(s), but also the patient’s name during local cases.  It also reminds the nurses of the procedures when breaks are given and makes sure all the procedures listed are completed.
• We have recently added a “Terminal Time-Out” (“T-T” for short to avoid sounding morbid in front of an awake patient).  The circulating nurse states only the patient’s name and procedure(s) at the time of skin closure, immediately before the sponge and instrument counts.  We added the “Terminal Time-Out” to the nurses’ op record sheet as part of the “debriefing.”   It takes 5 seconds.  I was pleasantly shocked that all the nurses were on board from day one.  Try it if you haven’t already been doing it.  Feedback welcome.