By- Dr. Joan Marie Pellegrini
Most of us know that if we need surgery, we need to choose a qualified surgeon. We then assume that the surgeon and their hospital will do everything they can to prevent any post-operative complications. Unfortunately, the medical community has known for decades that surgical quality is heterogeneous across the country and sometimes even within a state or city. It is not news that some hospitals have lower complication rates than others. There has been quite a bit of research into what these high performing hospitals are doing that may be leading to better results. Fortunately for the consumer, there are now several national quality partnerships aimed at improving processes within the operating room and recovery room to actively reduce post-operative complications.
These quality measures are attempting to "hard wire" certain processes. "Hard wiring" means that something will happen based on protocol rather than on individuals having to remember to ask for it to happen. Many industries have proven that protocols lead to better results compared to letting individual practitioners deciding what to do. Getting a patient ready for surgery and then recovering the patient is a very complex process and it is quite easy to forget seemingly unimportant details. We have good surgical results in this country but the goal of these quality initiatives is to have excellent results and to decrease our complications from surgery by at least 25%. Most of these initiatives started several years ago and there has been excellent progress.
The quality measures differ somewhat depending on the type of surgery. However, it is now mandatory to do a "time out" prior to making an incision to make sure that everything that needs to be done has been done. Some of the things this" time out" verifies is that the team agrees they have the right patient and the correct procedure according to the consent form, the right antibiotic has been given if indicated and at the right time, that certain medications have been given if indicated, and that the necessary equipment is available and functional.
Other measures that are addressed are the patient's temperature and glucose level. Special warming devices are used to prevent hypothermia during surgery. Also, if the patient's blood glucose level is elevated, they will be given insulin even if they are not diabetic in order to prevent certain post-operative complications. Extra oxygen is given to all patients after some types of surgery because it has been shown to reduce wound infections. These above measures are why some patients wake up in the recovery room with oxygen and insulin drips even though they do not have lung disease or diabetes.
The good news is that there are many national quality measures that are being put into practice and are working to reduce complications as a result of surgery. Because these are national measures, you can be confidant that you will be given the same care no matter which hospital you go to as long as that hospital is participating in these programs. In the future, there will be even more quality programs nationally in an attempt to standardize care across the nation.
If you would like more information you may search for SCIP (Surgical Care Improvement Project) or ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program).
Proper Post-Operative Care
By- Dr. Joan Marie Pellegrini
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