Take These Steps for Safety When You’re Having Heart Surgery

Ask questions and be sure questions are asked of you
Take These Steps for Safety When You're Having Heart Surgery

Contributor: Douglas Johnston, MD

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Patient safety is a major concern in any hospital setting and in cardiac and vascular surgery it underlies every action we take, every day.

We use very specific and standardized rules to ensure that patients receive the correct treatments and procedures and that they have the best outcome possible.

If you are going to have heart surgery, be sure to ask about the hospital’s safety procedures and checklists. Doctors and nurses should be asking you questions, taking your medical history and helping you get safely into and out of the operating room, through recovery and ultimately, back home.

Check and double-check

Before any surgery, staff should check and double-check details that might seem ordinary to you, but are of great importance for the procedure.

These details include your name and the type of surgery you are scheduled to have. They also should make sure there have not been any medical changes since the last time you saw your medical team — even if it was the day before.

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Different members of the medical team should ask you many questions. Different people might repeat the same question.

We ensure patient safety by using checklists for our surgical procedures. These checklists cover a patient from the minute he or she enters the hospital, into the operating room, all the way through the end of surgery  Following checklists is a way to ensure that every procedure is done in a consistent manner and the safety is maximized for every patient.

Forming a huddle

The team huddle is an integral step performed before the start of surgery — it makes sure everyone knows the plan and all questions are answered.

  • The surgeon describes the operative plan, any special instruments that are needed and any concerns he or she has.
  • The nurses verify all correct documentation and make sure they are prepared.
  • The anesthesiologist discusses the plan and any concerns he or she may have for surgery.
  • The perfusionist discusses the heart bypass machine and plans related to perfusion during surgery.

Just before the surgery begins, a time-out occurs. Time-outs ensure the correct patient is there, the correct procedure is planned, and everything is in place to start the surgery. Then at the end of surgery, the sign-out occurs — a time to make sure that all is complete and everyone is knowledgeable about the status of the patient.

Building in redundancy

In cardiac and thoracic surgery, routine and repetition are good. We work together with the same teams every day and this is very important. For the teams to function well, teams need to know each other well.

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I have a team of circulating RNs, scrub techs, perfusionists and operative assistants with whom I work routinely. We establish a bond and a comfort level working with each other. People decide what teams they want to work with and that builds cohesiveness and respect. Each team member needs to feel confident that he or she can speak up with any questions or concerns, which improves patient safety. Ask your surgeon how he selects his team and how long the team has worked together.

In our communication in the operating room, we operate on a principal borrowed from aviation, which is “no rank in the cockpit.”  What this means is we use first names rather than titles, encouraging an atmosphere where any member of the team can speak up with a concern or question and help to identify issues before they become serious.

The thought of having heart surgery can be scary, but knowing that you have an experienced surgeon and surgical team who follow safety standards and checklists can put your mind at ease. Don’t be afraid to ask questions to find out about how they will be taking care of you.

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