Small Changes, Stark Differences: Errors in Otolaryngology

Standardization can also be a boon to preventing errors, and yet does not have to take away from a clinician’s autonomy.9 Indeed, we would argue, the opposite is true, said Dr. Shah. It frees you up to practice the art of medicine. Standardizing forms or protocols allows the practitioner to focus on making the diagnosis and developing a relationship with the patient. He admits that he had to sell himself on this concept. Five years ago I thought that standardized tonsillectomy and adenoidectomy postoperative forms were ridiculous. … But now I ask, why am I spending the extra five minutes to write individual orders for each patient when a standard form that results in fewer errors takes me a minute to fill out? Then I can spend the extra four minutes talking to the patient or teaching the residents. It’s a mind shift, he said, that can help any otolaryngologist improve quality and safety.

My residents are getting trained with a different culture; and not just mine, this is a nationwide experience with patient safety and quality being inculcated into residency training. So hopefully 15 to 20 years down the road, the same surgeons will be training their residents with the culture of safety.

Preventing Errors: Easy Fixes Make a Difference

• Notice the details of what you and your colleagues and staff members are doing.
• Use and advocate for surgical time-outs.
• Follow good medication practices: medication reconciliation, read backs on verbal orders, limit abbreviations, keep look-alike and sound-alike medications in separate locations; make careful choices regarding drug labeling, packaging, and storage.
• Practice leadership from the top down.
• Look for ways to make small changes that can have large ramifications.
• Don’t resist standardization; it can support your autonomy.

Where Are Errors Made in Otolaryngology?

Errors in otolaryngology were classified as related to:

• History and physical = 1.4%
• Differential or final diagnosis = 1.4%
• Testing = 10.4%
• Surgical planning = 9.9%
• Wrong-site surgery = 6.1%
• Anesthesia = 3.3%
• Wrong drug/dilution on the surgical field = 3.8%
• Technical = 19.3%
• Retained foreign body = 0.9%
• Equipment = 9.4%
• Postoperative care = 8.5%
• Medical management = 13.7%
• Nursing/ancillary = 0.5%
• Administrative = 6.6%
• Communication = 3.8%
• Miscellaneous = 0.9%

Source: Shah RK et al. Laryngoscope 2004;114:1322-35.

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