Reducing Surgery Scheduling Errors

Purposes/Aims:  The purpose of this patient safety research is to determine whether team training with bundled interventions for surgeons and multidisciplinary staff involved with surgery scheduling will improve the accuracy of surgery scheduling, thereby minimizing scheduling factors that contribute to the occurrence of wrong site surgery (WSS).  A quasi-experimental design will be utilized to apply interrupted times series analysis.  The research addresses the following aims:  1) To describe and compare overall surgery scheduling error incidence rate and type, and error incidence rate and type by surgery specialty department before and after implementation of bundled team training interventions for surgeons and multidisciplinary staff; and 2) To determine if the trend of surgery scheduling errors is altered after implementation of bundled team training interventions.

Rationale/Conceptual Basis/Background:  Despite decades of patient safety research, medical errors occur at an alarming rate and may result in life-threatening disabilities, extended hospitalization, or death.  Preventable egregious medical errors include wrong patient, wrong site, and/or wrong procedure surgery.  Approximately 40 WSS occur weekly in the United States.  Position statements, guidelines, and checklists have failed to decrease the incidence of WSS.  Moreover, The Joint Commission has reported 39% of WSS examined began with a surgery scheduling error.  The incidence of surgery scheduling errors range between 0.41% to 5.3%; however, research and preventative measures are limited.   

Methods:  Utilizing quasi-experimental research, prospective data will be collected from a Health Care System (HCS) in southern Washington State.  The HCS centralized scheduling department schedules an average of 100 surgery cases daily.  Surgery scheduling error data will be collected before and after delivery of team teaching with bundled interventions.  Frequency distributions of scheduling error types and surgery specialty will be reported.  To determine the effect of a bundled team training intervention that consists of training with bundled interventions above and beyond the underlying secular trend, an interrupted time series with segmented regression will be utilized.

Results:  Expected results will provide insights as to the incidence and types of surgery scheduling errors and effectiveness of bundled team training as an intervention to reduce the incidence of surgery scheduling errors. 

Implications:  This novel and innovative patient safety research, with an estimated sample of 12,000 surgery cases, is needed to identify effective patient safety strategies to minimize surgery scheduling errors and patient risk.  The expected outcome of this research is to provide evidence that an additional layer of protection may be added to minimize the risk of wrong site surgery by strengthening the processes that occur on the front end of the patient experience beginning with surgery scheduling.  The study results have the potential to influence local and national standards, guidelines, and position statements to promote safe patient care throughout the perioperative surgical continuum.