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Review Question - QID 214060

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QID 214060 (Type "214060" in App Search)
A 31-year-old man is scheduled to undergo a right shoulder arthroscopic labral repair. The surgeon is running behind and hurries to the preoperative holding area. The surgeon greets the patient and verbally confirms the operative site with the patient. The surgeon leaves the patient’s room and completes the appropriate preoperative paperwork outside the room. The patient is taken to surgery and receives an interscalene block on the left shoulder after sedation. At the final Time-Out, the surgeon realizes a discrepancy with the laterality when the consent is read aloud. The surgeon aborts the case and wakes the patient. What is the correct sequence of events that should have happened to prevent this error?

A: The surgeon begins the surgery
B: The surgical team performs a Time-Out
C: The surgeon marks the surgical site
D: The surgeon reads the surgical information on the consent to the patient
E: The anesthesia team administers a local extremity block

E, C, B, D, A

1%

21/3376

D, B, C, E, A

7%

231/3376

D, C, E, B, A

83%

2812/3376

C, D, E, B, A

7%

223/3376

D, E, B, C, A

1%

30/3376

Select Answer to see Preferred Response

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The correct sequence of events should be the surgeon reads the surgical information on the consent to the patient, then the surgeon marks the surgical site with the patient’s assistance, then allows the anesthesia team to perform their procedure, and then performs a final Time-Out with the surgical team immediately prior to the surgical incision.

Orthopedic surgical patients are at risk of surgical errors due the number of procedures that can be performed on the bilateral extremities. The responsibility to identify the correct surgical procedure at the correct location has expanded beyond only the surgeon. The entire surgical team is responsible for confirming the patient, surgical site, and surgical procedure. All members on the surgical team should be valued and emboldened to “speak up’ and actively participate. To help improve communication and reduce complications, surgical safety checklists have become common. In a statement published by the AAOS is 2015, they support the use of standardized surgical systems, including the use checklists, as it is critically important to keep patients safe. In 1998, the AAOS introduced the “Sign Your Site” safety program to reduce wrong-site surgeries through improved site identification. Permanent ink should be used to mark the site(s) with the patient's assistance prior to surgery, and the site(s) should be confirmed by the surgical team during the Time-Out immediately before the start of the surgical procedure.

Singer et al. performed a study to evaluate the association between surgical teamwork and surgery safety checklist performance. Their results emphasized the importance of surgeon buy-in and clinical leadership to initiating and maintaining surgical safety checklists. In addition to surgeon buy-in and clinical leadership, factors that help maintain high-quality and consistent surgical teamwork were communication, coordination, respect, and assertiveness.

Incorrect Answers:
Answers 1, 2, 4, 5: These sequences of events are not recommended to confirm the patient, surgical site, and procedure accurately and effectively.

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