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15 Essential Risk Management Strategies For Surgeons

Surgeons face various risks in day-to-day practice. Adverse outcomes related to surgical treatment, diagnosis, and medical treatment can result from a variety of factors, including issues with technical competency, clinical judgment, communication, documentation, and more. The following list offers 15 essential strategies to help surgeons mitigate risks and enhance patient safety.

  1. Participate in ongoing performance improvement opportunities to enhance technical surgical skills and ensure competency (e.g., mentoring, continuing education, and ongoing practice performance evaluation/appraisals).

  2. Use evidence-based guidelines (e.g. NICE, Royal College of Surgeon Guidelines) and clinical pathways to standardise processes, improve efficiency, and support quality care.

  3. Consider using decision support systems, consultations, and multidisciplinary team decision-making to support clinical reasoning and avoid errors in clinical judgment.

  4. Implement protocols for team-based communication, including protocols for care transitions, telephone triage, and communication with radiology regarding incidental findings on diagnostic studies.

  5. Communicate adequate, clear, and appropriate information to patients. Conduct thorough informed consent discussions, provide patient education in a format that is clear and unambiguous (1), and encourage patients to participate in their care.

  6. Use a technique — such as teach-back (also called ‘show-me’)— to gauge patient understanding by confirming whether the patient understands what is being explained to them, which reduces the risk of miscommunication, and supports patient adherence to care plans.

  7. Perform complete patient assessments and ensure timely ordering of tests and consults to prevent problems associated with ruling out or documenting abnormal findings.

  8. Review patient selection criteria for each procedure, reconcile patient medications, and ensure that all appropriate health information is available in patients’ health records (if a private patient, include a copy of your personal notes in the patient’s hospital records.)

  9. Verify that all necessary equipment and supplies are available prior to the start of each procedure.

  10. Participate in surgical team timeouts prior to commencement of surgical procedures. Participate in the completion of the WHO Surgical Checklist. Encourage “speaking up” behaviours to address potential safety issues in accordance with principles set out in the National Safety Standards for Invasive Procedures 2015 revised in 2019 (2).

  11. Use safety precautions throughout each procedure, such as proper patient positioning, infection control best practices, and surgical item counts.

  12. Following surgical procedures, hold team debriefing/huddle sessions to identify opportunities for improvement at the end of the case/theatre list.

  13. Document a complete, concise, and accurate operative report the same day of each procedure. Ensure the entry is dated, timed and signed.

  14. Maintain a consistent assessment process following procedures, and evaluate patients against established discharge criteria prior to releasing them.

  15. Document all instances of patient non-adherence as they occur using objective information, and document any follow-up education provided to the patient or caregiver to address non-adherence.

  1. https://www.england.nhs.uk/ourwork/patient-participation/health-decisions/

  2. https://improvement.nhs.uk/resources/national-safety-standards-invasive-procedures/

Laura M Cascella
MA, CPHRM

Anne E Jenkins
MSc, RGN, CIRM

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, please contact your solicitor, legal advisor or other professional advisors if you have any questions related to your legal or medical obligations or rights, applicable law, contract interpretation, or other legal questions.
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