Staying safe: simple tools for safe surgery.

Richard C. Karl

Commentary

Staying safe: simple tools for safe surgery.

April 25, 2007

Karl RC. Bull Am Coll Surg. 2007;92(4):16-22.

View more articles from the same authors.

The author uses examples from his experience as a pilot to discuss aviation safety strategies, such as crew resource management, that can be applied to improve safety in surgery.

PubMed citation

Related Resources From the Same Author(s)

Adverse events: root causes and latent factors.

February 15, 2012

Briefings, checklists, geese, and surgical safety.

January 13, 2010

A human factors subsystems approach to trauma care.

August 27, 2014

Pharmacists' perceptions of computerized prescriber-order-entry systems.

August 8, 2007

Is the future of medical diagnosis in computer algorithms?

May 29, 2019

The collapse of sensemaking in organizations: the Mann Gulch disaster.

March 6, 2005

Organizational culture as a source of high reliability.

March 6, 2005

Quality initiatives: developing a radiology quality and safety program: a primer.

August 26, 2009

Hospitals as cultures of entrapment: a re-analysis of the Bristol Royal Infirmary.

April 25, 2007

The new CMS hospital quality star ratings: the stars are not aligned.

November 9, 2016

An evolving hospital quality star rating system from CMS: aligning the stars.

May 26, 2021

Improvement of medication event interventions through use of an electronic database.

December 18, 2013

Coronavirus disease 2019 (COVID-19) pandemic, central-line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): the urgent need to refocus on hardwiring prevention efforts.

February 7, 2022

The normalization of deviance: do we (un)knowingly accept doing the wrong thing?

October 20, 2010

Oversedation of a patient with obstructive sleep apnea prior to imaging.

February 21, 2018

Insulin dosing error in a patient with severe hyperkalemia.

January 17, 2018

Defining patient safety events in inpatient psychiatry.

August 22, 2018

Hospital characteristics associated with penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program.

August 5, 2015

A mixed-method study of practitioners' perspectives on issues related to EHR medication reconciliation at a health system.

May 8, 2019

Management of a patient with a latex allergy.

January 25, 2017

Wrong-site surgery.

December 13, 2017

Retained lumbar catheter tip.

April 5, 2017

Resident duty hours and medical education policy—raising the evidence bar.

April 12, 2017

Rapid response teams as a patient safety practice for failure to rescue.

July 7, 2021

Safety culture as a patient safety practice for alarm fatigue.

October 13, 2021

Quality and safety in surgery: challenges and opportunities.

September 8, 2021

The Preventable Harm Index: an effective motivator to facilitate the drive to zero.

October 27, 2010

Development of an online morbidity, mortality, and near-miss reporting system to identify patterns of adverse events in surgical patients.

April 22, 2009

Another medical malpractice crisis?: Try something different.

October 14, 2020

Ethical considerations in the development of the Flexibility in Duty Hour Requirements for Surgical Trainees trial.

October 26, 2016

A case for improving measurement of intraoperative iatrogenic injuries.

July 23, 2014

Emergency hospitalizations for adverse drug events in older Americans.

December 7, 2011

Burnout in healthcare: the case for organisational change.

August 28, 2019

A comprehensive patient safety program can significantly reduce preventable harm, associated costs, and hospital mortality.

August 21, 2013

Association between hospital safety culture and surgical outcomes in a statewide surgical quality improvement collaborative.

May 15, 2019

Potentially inappropriate medications in a large cohort of patients in geriatric units: association with clinical and functional characteristics.

June 19, 2013

The impact of clinically undiagnosed injuries on survival estimates.

February 11, 2009

Sleep deprivation and error in nurses who work the night shift.

February 19, 2014

Gender-based differences in surgical residents' perceptions of patient safety, continuity of care, and well-being: an analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial.

March 15, 2017

Development and validation of a tool to improve paediatric referral/consultation communication.

August 3, 2011

Making communication and resolution programmes mission critical in healthcare organisations.

November 11, 2020

Labeling morphine milligram equivalents on opioid packaging: a potential patient safety intervention.

August 22, 2018

Adverse events in Veterans Affairs inpatient psychiatric units: staff perspectives on contributing and protective factors.

September 20, 2017

Hospital complications: linking payment reduction to preventability.

May 6, 2009

Resident attitudes regarding the impact of the 80–duty-hours work standards.

September 14, 2005

Association between surgeon technical skills and patient outcomes.

September 9, 2020

Surgical residents' work hours and well-being in year 2 of the FIRST trial.

July 26, 2017

Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system.

January 27, 2016

Six habits to enhance MET performance under stress: a discussion paper reviewing team mechanisms for improved patient outcomes.

September 30, 2015

Underlying reasons associated with hospital readmission following surgery in the United States.

February 18, 2015

Disclosure, apology, and offer programs: stakeholders' views of barriers to and strategies for broad implementation.

January 9, 2013

Quantification and classification of errors associated with hand-repackaging of medications in long-term care facilities in Germany.

December 10, 2008

Honesty and transparency, indispensable to the clinical mission--Parts I-III.

December 15, 2021

Probabilistic risk assessment of accidental ABO-incompatible thoracic organ transplantation before and after 2003.

February 6, 2008

Adapting rapid assessment procedures for implementation research using a team-based approach to analysis: a case example of patient quality and safety interventions in the ICU.

April 1, 2020

Measuring adverse events in hospitalized patients: an administrative method for measuring harm.

September 7, 2016

Application of the human factors analysis and classification system methodology to the cardiovascular surgery operating room.

April 11, 2007

Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.

November 21, 2007

Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites.

March 25, 2021

Challenges with implementing the Centers for Disease Control and Prevention opioid guideline: a consensus panel report.

April 3, 2019

Liability claims and costs before and after implementation of a medical error disclosure program.

August 25, 2010

Evaluation of reasons why surgical residents exceeded 2011 duty hour requirements when offered flexibility.

June 20, 2018

Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study.

June 22, 2016

Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services overall hospital quality star ratings.

June 7, 2017

Implementation of diagnostic pauses in the ambulatory setting.

February 14, 2018

Trends in anesthesia-related liability and lessons learned.

March 6, 2019

Organizational and cultural changes for providing safe patient care.

August 3, 2005

AHRQ focuses on ambulatory patient safety.

May 6, 2015

This isn't my information! The impact of accurate identity management on patient safety.

April 17, 2013

Radiological error: analysis, standard setting, targeted instruction and teamworking.

August 24, 2005

Patient safety: a consumer's perspective.

April 27, 2011

Peer feedback, learning, and improvement: answering the call of the Institute of Medicine report on diagnostic error.

December 7, 2016

Engaging the patient and family in the surgical safety process utilizing SafeStart.

August 28, 2019

Improving the specificity of drug-drug interaction alerts: can it be done?

April 6, 2022

Patient safety event reporting in a large radiology department.

September 21, 2011

ASHP–PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems.

August 8, 2018

Development and validation of a brief culture-of-safety survey.

June 22, 2022

Prevalence, types, and sources of bullying reported by US general surgery residents in 2019.

June 17, 2020

Exploring emergency physician–hospitalist handoff interactions: development of the Handoff Communication Assessment.

March 17, 2010

Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance.

May 4, 2011

The safety stand-down: a technique for improving and sustaining hand hygiene compliance among health care personnel.

June 27, 2018

Physicians' beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior.

February 3, 2010

Cognitive performance-altering effects of electronic medical records: an application of the human factors paradigm for patient safety.

January 30, 2005

Quality improvement and patient safety organizations in anesthesiology.

April 29, 2015

What stands in the way of technology-mediated patient safety improvements? A study of facilitators and barriers to physicians' use of electronic health records.

December 21, 2011

Fallacious reasoning and complexity as root causes of clinical inertia.

August 29, 2007

Manic for medication safety: bar codes and drug information databases are helping to reduce medication errors.

February 21, 2007

Building a safety net.

August 30, 2006

The enterprise take on patient safety.

August 17, 2005

Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care.

February 24, 2016

Communication-and-resolution programs: the challenges and lessons learned from six early adopters.

January 15, 2014

Overriding drug-drug interaction alerts in clinical decision support systems: a scoping review.

September 7, 2022

Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people.

August 9, 2006

Patient perspectives on test result communication in primary care: a qualitative study.

April 29, 2015

Program director perceptions of surgical resident training and patient care under flexible duty hour requirements.

September 7, 2016

Relationship between state malpractice environment and quality of health care in the United States.

April 12, 2017

Trainees' perceptions of patient safety practices: recounting failures of supervision.

January 26, 2011

Self-reported violations during medication administration in two paediatric hospitals.

May 16, 2012

Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.

December 14, 2005

Can patient safety be measured by surveys of patient experiences?

April 30, 2008

Related Resources

WebM&M Cases

Airway Obstruction during Anterior Cervical Spine Surgery

February 28, 2024

Supporting nurses in acute and emergency care settings to speak up.

November 8, 2023

Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.

June 14, 2023

Use of technology to improve the adherence to surgical safety checklists in the operating room.

May 31, 2023

An evidence synthesis on perioperative handoffs: a call for balanced sociotechnical solutions.

April 5, 2023

Journal Article

Study

A novel approach for engagement in team training in high-technology surgery: the robotic-assisted surgery olympics.

March 29, 2023

Surgical teams' attitudes about surgical safety and the surgical safety checklist at 10 years: a multinational survey.

November 17, 2021

Society for Maternal-Fetal Medicine Special Statement: Surgical safety checklists for cesarean delivery.

September 22, 2021

We asked the experts: the WHO Surgical Safety Checklist and the COVID-19 pandemic: recommendations for content and implementation adaptations.

March 17, 2021

WebM&M Cases

Premature Closure: Was It Just Syncope?

November 25, 2020

WebM&M Cases

Lack of Sepsis Recognition Leads to Delay in Care Following Cesarean Delivery.

November 25, 2020

Developing perioperative Covid-19 testing protocols to restore surgical services.

July 22, 2020

Impact of the World Health Organization surgical safety checklist on patient safety.

June 12, 2019

Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist.

May 8, 2019

Bringing perioperative emergency manuals to your institution: a "How To" from concept to implementation in 10 steps.

April 3, 2019

Debriefing in the OR: a quality improvement project.

March 13, 2019

Simulation-based clinical rehearsals as a method for improving patient safety.

October 31, 2018

Safety stop: a valuable addition to the pediatric universal protocol.

September 5, 2018

Evaluation of a patient safety programme on Surgical Safety Checklist compliance: a prospective longitudinal study.

August 15, 2018

Creating a safer operating room: groups, team dynamics and crew resource management principles.

June 6, 2018

Enhancing pediatric perioperative patient safety.

November 29, 2017

Sustaining teamwork behaviors through reinforcement of TeamSTEPPS principles.

November 15, 2017

We are going to name names and call you out! Improving the team in the academic operating room environment.

June 21, 2017

Association of a surgical task during training with team skill acquisition among surgical residents: the missing piece in multidisciplinary team training.

June 7, 2017

Mobilising a team for the WHO Surgical Safety Checklist: a qualitative video study.

March 1, 2017

A QI initiative: implementing a patient handoff checklist for pediatric hospitalist attendings.

February 8, 2017

S-TEAMS: a truly multiprofessional course focusing on nontechnical skills to improve patient safety in the operating theater.

November 2, 2016

Using standardized OR checklists and creating extended time-out checklists.

October 5, 2016

Use of a surgical safety checklist to improve team communication.

September 21, 2016

Back to basics: counting soft surgical goods.

April 20, 2016

See More About The Topic

Operating Room

Physicians

Surgery

Surgical Complications

Forcing Functions

Staying safe: simple tools for safe surgery.

A novel approach for engagement in team training in high-technology surgery: the robotic-assisted surgery olympics.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Staying safe: simple tools for safe surgery.

A novel approach for engagement in team training in high-technology surgery: the robotic-assisted surgery olympics.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site