Small Changes, Stark Differences: Errors in Otolaryngology

But in addition, comparing their findings with those of Gawande et al.,15,16 they found that there were differences between general surgery and the surgical subspecialties. Whereas much of general surgery is related to issues of greater acuity, such as for trauma or major cardiac or abdominal surgery, in otolaryngology, perhaps 80 percent of our surgeries are elective, said Dr. Shah. And we’re a high-volume specialty. So the types of errors we have are going to be different than a specialty that does only two surgeries a day. Some otolaryngologists perform 10 surgeries on a routine operative day.

When they continued developing their research plans, said Dr. Shah, one of our conclusions was that specialists should stick with what they know. It does not make sense for us to start researching general surgeons, just as it doesn’t make sense for cardiologists to research otolaryngologists. If we’re going to get accurate numbers, it’s really pertinent that each subspecialty studies itself.

Preventing Errors

Otolaryngologists can prevent medical errors in their institutions and practices with some very simple practices. Keep your eyes open, advised Dr. Shah. Begin to carefully observe what’s going on around you and focus your attention on details. He believed his physician colleagues would be frightened by the number of errors that occur on a day-to-day basis, but they might be more impressed by how simple they are to fix.15,16

As a fellow in pediatric otolaryngology, Dr. Shah was ignorant to these commonly occurring errors, he said, but once I started researching medical errors, I would take an extra three to five minutes on my morning rounds and flip through some of the charts with the residents. They began to see that a note was sometimes lost or where they thought they had documented something, in fact they had not. Sometimes verbal orders weren’t signed or there were illegible signatures.

These were simple things that could easily be fixed, he said. And I was at fault as well. My signature is horrendous. And then I took a step back, and asked myself: What if there is an emergency and the nurse needs to call the attending surgeon and she can’t read my signature? Although he signs his last name the same way, he now prints SHAH and adds his pager number.

Another simple remedy is the time out procedure, now a mandate of the Joint Commission for the Accreditation of Healthcare Organizations. Another means of helping to prevent errors is to know the names of all your teammates-everyone in the surgical suite. If there’s an emergency, when you know people’s names you can communicate better, said Dr. Shah. Dr. Roberson, Dr. Shah’s research mentor, routinely writes down the names of all team members in the operating room at the beginning of the day. This includes the circulators, the anesthesiologists and even the employees that turn over and clean the room between cases.