OPINION: Physicians should take full responsibility

I want to respond to the April Scope cover story, "Scalpel sleeves could remind teams to pause." Patient safety is the main priority in the OR. I think site marking and "the pause" are excellent, positive processes. As a thoracic surgeon, I often deal with laterality, so I understand very well the importance of such safety policies. Adding one more step by putting a cover on the scalpel will not change anything. The recent Twin Cities case illustrates that despite such processes, bad things can happen. My safety practices include:

• Always obtaining and reviewing the imaging studies in the OR before the operation.

• Placing the patient in proper position and confirming the side.

• Making sure the equipment is available and functioning properly.

The ultimate responsibility is in the hand of the surgeon. I believe the patient is safest in the OR, or elsewhere, when the physician takes full responsibility for all aspects of the patient's care. As a hospital system, we need to engage the physicians to take ownership of this responsibility.

Louis F. Jacques, MD, thoracic surgeon, Fairview Southdale Hospital

RESPONSE: Physicians are part of a larger patient safety system

Dr. Jacques,

Thank you for contacting us about the Scope article. I appreciate your sense of individual accountability related to keeping patients safe. Individual responsibility is a necessary, but not sufficient component of a safe system. Increasingly in the OR, physicians are becoming participants in the greater system. Physicians and other clinicians must actively participate in creating and managing those systems.

To address errors in the OR, hospitals across Minnesota have collectively initiated practices such as site-marking and the pre-procedure pause that you use. Overall, the efforts are working. In the first year of reporting OR events to the state, 84 percent of wrong patient, wrong procedure or wrong site events occurred in the OR. In the last report (fourth year), 67 percent of reported incidents occurred in the OR.

We still need to improve. As in other high-risk industries, such as aviation, health care organizations are introducing human factors science, of which the orange scalpel cover is one recommendation. As a community and as a system, we are learning as we go and need further dialogue.

Alison Page, MS, MHA, Fairview chief safety officer

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