Outpatient surgery magazine recently published an interesting article on why preventable surgical mistakes keep happening.  This article is not talking about the unusual outcome that occurs because of a surgical emergency.  Rather, this article discusses that despite universal use of checklists and time outs, completely preventable mistakes like wrong site surgery, wrong surgical procedure, medication errors, or other entirely preventable medical errors continue.     

It points to two primary causes:  over aggressive surgical scheduling and lack of uniformity.   Overly aggressive surgical scheduling occurs because hospitals and surgery centers set goals for the productive use of their OR suites.  They want this space utilized to its capacity to ensure revenues on these  profit center are maximized.  To ensure this, hospitals schedule surgeries at intervals that are often not realistic.  Surgeries that will take 90 minutes are scheduled to last 80.  Over time, the OR staff gets backed up, and they rush to catch up.  As we all know, when a person rushes, they make mistakes. 

Second, often, each surgeon wants things done a certain way.  This surgeon wants a time out run one way, the next another.  One surgeon has specific details regarding pre op routines, another something different.  This becomes challenging for the OR staff to remember each surgeon's different preferences.  As a result of a lack of uniformity, important steps are missed or overlooked.  This again, contributes to preventable errors.

The solution recommended by the article is nurses need to be advocates for their patient's safety.  They need to refuse to be rushed and insist on realistic surgical scheduling times.  They need to press their surgeons for uniformity in the OR. 

These preventable errors will not stop if the solution is nurses standing up their corporate overlord hospital or demanding surgeons.  A consciences nurse will quickly find herself out of a job, and others will learn from that example that standing up for patient safety only puts a nurse on unemployment.  Rather, there needs to be a top down commitment from hospitals to not schedule too many surgeries and surgeons to buy into uniformity before these entirely preventable errors will be stopped.