The goal of the Dartmouth-Hitchcock Operating Room Safety Initiative is to help ensure the safety of all patients and professionals in our operating rooms.
We begin by examining the underlying causes of common incidents that endanger the safety of those present in the operating room (OR), and by trying to anticipate unexpected events. We then modify our existing processes and procedures to include a regimen of preparatory tools to increase awareness, preparedness, and participation by our staff.
These modifications do not add significant time to conventional preparation and should decrease the risk and severity of hazardous events.
Fires in the OR
OR fires, although relatively rare, are devastating events for the patient, family, surgeon, and OR personnel.
Although the mechanisms for fires are well understood (a flammable source, fuel, and oxygen), these events are a surprise and most often personnel are unprepared. "Time outs", group pauses performed prior to surgical procedures, are intended to enhance patient safety through the regimented use of preparatory tools (e.g., checklists). We modified our existing time-out process in an effort to both increase personnel participation in the time-out and to use that process to promote fire safety. We videotaped the modified time out using DHMC OR personnel.
As shown in the video, we confirm the right patient and procedure. At the end of the time-out process, we discuss various steps each OR team member would take to prevent a fire and steps team members would take in the event of a fire. For example, the surgeon would remove the endotracheal tube, the anesthesiologist would reduce the oxygen saturations during the case and the OR scrub tech would smother the fire and pour saline. Each participant states his or her role prior to starting the case.
The modifications do not add significant time to the conventional time-out process and could be universally adopted. Although our institution has not had a fire in the OR, increased awareness through education as well as minor changes to the time-out process should decrease the risk of a future event by highlighting enhanced prevention techniques. This new process should also diminish the negative outcomes from such an event because of a more rapid and appropriate response by trained personnel.