New York State Health Department Releases Pre-Operative Protocols to Enhance Safe Surgical Care

Albany, February 8, 2001 – The New York State Department of Health released recommendations from its Pre–Operative Protocols Panel as part of a statewide effort to further safeguard patients' care during surgical procedures.

"New York State is committed to providing residents access to quality health care in a cost effective manner and paramount in that is patient safety," said State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H. "In working with the Governor to reduce medical and surgical errors, we believe very strongly that enhancing communication among health care providers and increasing practitioner awareness combined with strong provider protocols will aid in increasing patient safety measures currently in place."

Dr. Novello appointed the 12–member panel, including nine physicians and three registered nurses, last June in response to increased scrutiny of proper patient care in our nation's hospitals and the Department's detection of some critical patient care errors including: the wrong patient in the operating room, surgery performed on the wrong site or side, wrong procedure performed, failure to communicate patient condition changes, disagreements regarding stopping procedures and failure to communicate/report errors.

After reviewing policies and procedures from a variety of hospitals and protocol and guideline information from physician and nursing associations, other states, the Internet and the Institute of Medicine report of 2000 and listening to public input, Commissioner Novello adopted these recommendations as a standard of care for hospitals to ensure safe patient care outcomes and avoid these surgical errors in a variety of patient care settings:

  • Hospitals should develop and implement policies and procedures to assure there are at least three independent verifications of the surgical site, location and correct patient identification.
  • The attending physician should sign the consent form prior to the induction of anesthesia, confirming the accuracy of the document including the description of the procedure.
  • As one of the three independent verifications, it is recommended that the surgeon of record mark or unequivocally identify the site and/or side prior to surgery. The marking technique should be determined by the facility.
  • Whenever possible, the surgeon of record or his/her designee, should physically see and talk to the patient in the peri–operative area on the day of surgery.
  • When laterality (the procedure is specific to one side of the body) is at issue, the words or should be spelled out in their entirety, on the operative schedule and the operative consent form.
  • The anticipated level(s) for spinal surgery should be indicated on the operative schedule and the operative consent form. Levels may be modified later if operative findings indicate differences.
  • For operating room settings (for other settings, use appropriate personnel), the circulating nurse will:
    • Ensure the correct patient is present;
    • The consent has been signed by the surgeon of record on the day of surgery;
    • The appropriate surgical side/site has been identified/marked;
    • The surgeon has selected for display appropriate and relevant radiological films for the planned procedure (the surgeon of record determines what is appropriate and relevant); and
    • Ensure there is agreement as to the planned procedure, which has been verified with the surgeon, anesthesia personnel and circulating nurses. The agreement must be documented in the medical record.

Another key area that was discussed was how best to maintain open lines of communication among surgical team members and with patients. It was agreed that facilities should define the responsibilities of each staff member involved with the procedure and that there should be verbal communication regarding consent, marking, and/or appropriate equipment and supplies. The panel stresses the need for the surgeon, anesthesia personnel, and the circulating nurse to discuss patient issues and the planned procedure prior to the commencement of the procedure to ensure that all are familiar with the strategies and expectations for conducting the procedure; any special issues or potential problems should be identified and discussed. To further enhance communication, the patient's medical record should be fully documented.

The panel calls for each health care facility to have a policy on dispute resolution that should address such areas as discussions between physicians, failure to disseminate critical information, conversations whether or not to continue a procedure and communications between nurses and physicians. According to the panel, if there are any discrepancies in information or disagreements regarding the procedure/equipment/supplies, the surgical procedure is to be delayed until the issues are resolved.

Hospitals and other health care facilities throughout the State are expected to have a policy which, at the very least, includes these issues. The facilities can add to the guidelines and implement them in the manner best suited to their operation. Once implemented, they will assist medical personnel in providing high quality and safe patient care and in bringing uniformity to the patient care process.

2/8/01–12 OPA