OR Manager August 2022 - 18

Patient Safety
Patient safety starts from understanding different perspectives
BY IVY MONTGOMERY
n 2021, Patient Safety in Surgery
published the article, " Incidence
and OR team awareness of nearmiss
and retained surgical sharps: A national
survey on United States operating
rooms, " from a nationwide survey with
over 400 surgeons, anesthesiologists,
OR nurses and surgical technologists
on the frequency of lost and retained
sharps. The article further discusses
the surprising discordance among the
groups.
I
Here, we focus on the different perspectives
and why the above groups
view the issue differently. Like the story
of the blind man and the elephant, people
will claim to know the absolute truth
based on their limited and subjective
views. However, there is no room for
shortsightedness in the OR, where ignoring
other people's experiences can
compromise patient safety.
This article discusses the causes
of different views in order to apply the
same open-minded techniques in other
situations where discordances could
exist.
Assessment methods
To understand the discordance among
the groups, the views of surgeons were
compared to those in a combined group
of anesthesiologists, nurses, and technologists.
Binomial logistic regression
was performed to assess the likelihood
of these events reported by surgeons:
➊ No surgical sharps were lost and
a miscount of sharps happened in
> 2% of surgeries in the last year.
➋ 100% of lost sharps were recovered
before a surgery was completed
in the last year.
➌ A portable X-ray was used 100%
of the time to aid in the recovery
of lost sharps.
A pairwise comparison was used
to reveal statistically significant differences
in media scores between:
* surgeon vs anesthesiologist groups
* surgeon vs nurse/technologist
groups.
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OR Manager | August 2022
➊ Miscount of sharps never
happens
For the question, " In the last year, how
often have you witnessed a miscount
for a surgical sharp? " , significant dissonance
was found between the surgeon
and anesthesiologist groups on how
often they believe miscounts " never "
happen:
* Roughly 20% of surgeons believe
they never had a miscounted sharp
over the last year.
* Roughly 5.3% of anesthesiologists
reported miscounted sharps never
happened over the last year.
➋ Lost sharps not recovered
prior to surgery completion
For the question, " What percentage of
witnessed lost sharps were not recovered
prior to completing a surgery in
the last year? " , a statistically significant
delta was found between the anesthesiologist
vs. surgeon, and nurse/technologist
vs. surgeon views:
* 54.3% of anesthesiologists vs
30.3% of surgeons
* 50.8% of nurses/technologists vs
30.3% of surgeons.
➌ Used portable X-Ray frequency
For the question, " Over the course
of your career, how often is portable
X-Ray used to aid in the recovery of lost
sharps?, " more than half (56.8%) of
surgeons reported using X-Ray 100% of
the time to manage lost sharps. On the
other hand, both anesthesiologists and
nurses/technologists believe the percentage
is closer to a third of the time.
Interestingly, despite the disagreement
on how often X-Ray is used, all
three groups agreed that X-Ray is only
effective between 26-50% of the time
in identifying lost sharps. More importantly,
they all concurred that the use of
X-Ray adds 31-40 minutes to the procedure,
with an additional 21-30 minutes
spent searching. The total equates to
50-70 minutes of OR time added per
lost sharp event.
What are the causes of the
different perspectives?
To dive deeper into the causes of the
differing perspectives, we pulled data
from the Patient Safety in Surgery article
and interviewed both a surgeon and
an OR manager:
* Sam Weprin, MD, identified as " surwww.ormanager.com
http://www.ormanager.com
OR Manager August 2022

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