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„It Is Too Early to Pass a Law“
Dr. Gerald Burgard
© Helios Klinikum Erfurt
MEDICA.de spoke to Gerald Burgard, head physician of Helios Klinik for anaesthesia, intensive medicine and pain therapy in Erfurt, Germany, about confound patients, forgotten swabs and laws.
MEDICA.de: Mr. Burgard, due to the checklist the identity of a patient has to be checked before the anaesthesia. Has the patient to show his identity card on your operating tables now?
Gerald Burgard: No (laughing), that is not necessary. If we want to operate Mrs. Miller then it is ok if she affirms our question: “Are you Mrs. Miller?”
MEDICA.de: Is this really necessary? The patient’s name is also written in the medical record.
Burgard: That is true. However, it can happen that the doctor has the wrong patient record in his hands. In some cases the patient arrives in the operating room in deep sleep due to drugs he has been given before. Then he cannot answer such a question and so Mrs. Miller can turn into Mrs. Smith very quickly. The danger of confusion is a problem especially if the staff in the operating room sees she patient for the first time. In large hospitals this is no isolated case. Using the checklist, the doctors and nurses can find this out more quickly and have the chance to consult a doctor or a nurse who knows the patient.
MEDICA.de: Before the surgical intervention the staff speaks about possible complications during surgery and clean instruments. Before the patient leaves the operating room the staff checks needles and instruments and counts the swabs. Did you not do that routinely up to now?
Burgard: That should be routine but it seems that many doctors do not practise it systematically. The most important point of the checklist is that every step is communicated aloud. In doing so more mistakes are to be eliminated.
MEDICA.de: A study of the WHO has shown exactly this. Thus, severe complications can be reduced by one third, the death rate even by 40 percent. Why is it not regulated by law to use the list?
Burgard: It is too early to pass a law. The WHO study is only one large study on this topic. Although the results show promise we have to wait if doctors’ mistakes really can be reduced. They often surface only after many years. And we know that some study results turn out wrong later on. If we can show that we save lives by using the list other hospitals will also use it, I think.
MEDICA.de: Why do mistakes happen in surgery again and again?
Burgard: Communication during the surgical process is very important. Each of the staff has certain functions. If they are not communicated to other team members, mistakes have a walk-over. It is possible for example that the surgeon lays down a patient on the operating table in another way as it was planned. Then the anaesthesiologist also has to react spontaneously. The risk to make a mistake rises. Another example could be that a surgeon observes x-rays of a patient once again and decides another way of proceeding. If the other team members do not know this beforehand an important surgical instrument might be missing. The checklist should prevent such things because every step is communicated loudly before the surgical intervention. Good workflow of a team is very important, especially in emergencies.
MEDICA.de: Why do mistakes appear so often in routine surgery?
Burgard: One example is want of care. The doctor thinks: “This only is an appendix” and does not concentrate enough. Unplanned happenings also can appear if a surgical instrument is broken or the wound starts to bleed. Than a swab is taken to stop the bleeding but the doctor neglects to remove it. However, these are isolated cases. In less than one percent of surgical proceedings such mistakes appear. But these are mistakes which we also have to eliminate. That is why we use the checklist.
MEDICA.de: Do you think that the checklist will become standard in hospitals?
Burgard: I think so. In our hospitals the acceptance is very high and I think that other hospitals do it the same way in future.
The interview was conducted by Simone Heimann.