By Mike Blankenship, PepperDigital
Rhode Island Hospital, in Providence, was fined $150,000 by the state's Department of Health after a surgeon operated on the wrong finger of a patient in October. Ever more astonishing is that the same hospital has conducted five "wrong-side surgeries" since 2007. My first reaction is why is this hospital still open? Why hasn't the administrator been fired?
The fine levied by the Department of Health will pale in comparison to the subsequent medical malpractice suit. In addition to the fine, the hospital is going to be required to install video cameras in all operating rooms, and all surgeries will be monitored by a clinical professional--not on the surgical team--trained in surgical safety measures. Why wasn't this done after the first botched surgery?
An even simpler solution, and perhaps an added protective measure, would be to Tweet the surgical procedures. There are examples of successful surgeries that have been broadcast via Twitter, including one we wrote about here.
Anyone who has had surgery knows that during pre-op, a nurse uses a marker to annotate which side of the body or body part is going to be cut open. Once inside the OR and on the table, the entire team, including the surgeon, discuss the procedure and everyone verbally agrees to what is going to happen and to which body part. All of this is done prior to the administration of anesthesia.
With a Twitter protocol in place, each step can be Tweeted in detail. The OR Tweeter would provide a detailed account of the procedure, including microblogging the pre-op confirmation discussion:
@RhodeIslandHospital: Dr. Jones has just asked Jim the Patient which knee has been marked for the surgery.
@RhodeIslandHospital: Jim the Patient has confirmed that his left knee has been marked and has confirmed that his left knee is undergoing the procedure.
@RhodeIslandHospital: Dr. Jones has verbally confirmed that he will operate on the left knee. The rest of the team has verbally agreed to the left knee.
@RhodeIslandHospital: Jim the Patient is now under anesthesia. Dr. Jones is making the first incision on the left knee.
This simple Twitter feed provides an additional layer of checks and balances for an obviously screwed up surgery department at Rhode Island Hospital. What is gained by Tweeting the surgery is an additional level of oversight. A patient's family can also follow each step of the procedure and interject with a direct reply to the OR if anything is Tweeted that is wrong. For example, in the above scenario, if any Tweet had contained "right knee" instead of "left knee," the family could have immediately sent a reply notifying the OR staff.
The other benefit of using Twitter in the OR is that it's free. Of course this requires an extra body in the room but using somebody already on your payroll is a lot cheaper than fines and malpractice lawsuits. Use a med student who is completing their surgery rotation. It could be used as a teaching tool or part of a "scared straight" initiative to demonstrate the need for situational awareness during surgery.
Comments