Note from Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon)*
In 2015, I was appointed by the American College of Surgeons (ACS) to serve as the ACS representative on The Joint Commission. I thought that it would be important to pick a topic that The Joint Commission was working on that might be particularly relevant to surgeons and to provide my interpretation and reflections on how that issue affected the practice of surgery. The Bulletin offered a vehicle to distribute that information throughout the surgical community, and given the myriad projects that go on every day at The Joint Commission to improve the delivery of health care throughout our nation, this exercise proved useful to me personally. Today, I am passing the proverbial baton to someone who needs little introduction—Dr. Lenworth M. Jacobs, Jr., a trauma surgeon who has contributed substantially as a surgical leader and whom the leadership of the ACS has asked to become a commissioner at The Joint Commission. I have been appointed to serve as vice-chair of the commission’s board, and Dr. Jacobs has graciously agreed to take on this regularly published article. I want to take this opportunity to thank Jon DePaolis at The Joint Commission, who helped me with the selection of the topics and the crafting of the column, and the entire Bulletin team, who carefully edited and embellished every one of those pieces. Lastly, I thank you, the readers who have followed this piece over the years. I hope you have found these articles useful in your pursuit of providing high-quality and safe patient care.
*Dr. Pellegrini is professor and chair emeritus, department of surgery, University of Washington, Seattle. He is Past-President, ACS, and Vice-Chair, The Joint Commission.
All surgical procedures carry inherent risks. However, some patients are unaware of those possibilities and other important aspects of an operation before they enter the operating room. According to a study published by the American Society of Anesthesiologists, an anesthesia resident at Rutgers New Jersey Medical School, New Brunswick, found that more than half of the patients he interviewed did not know what role the anesthesiologist played in their care.*†
The issue also extends to patients who are unaware that being prepared for a procedure means being healthy enough physically and mentally. Therefore, patients who lack a complete understanding of what their surgical procedure entails—or their role in ensuring a successful, safe procedure—may not fully benefit from surgery.
To assist in educating surgical patients, The Joint Commission launched a new Speak Up patient safety campaign in November 2020, which is focused on providing information on what a patient should know before and after an operation. The free campaign materials include the following:
- An infographic in both English and Spanish and in three different sizes (8.5˝ x 11˝, 11˝ x 17˝, and 24˝ x 36˝)
- An animated video, also available in both English and Spanish
- A distribution guide with recommendations on how health care facilities can use and provide the materials to patients and their families, caregivers, and advocates
Meanwhile, the Speak Up for Safe Surgery video provides an example of a patient and her advocates as they navigate through an elective operation. The video tracks Sofia’s journey, from before she undergoes a knee procedure through her postoperative rehabilitation.
As hospitals continue to meet the challenge of treating patients with COVID-19, it is possible that operations may shift to an ambulatory surgery setting to help alleviate some of the burden.
Preparing for an operation
The Speak Up for Safe Surgery infographic touches on several areas, such as how patients can plan for an operation by talking to the surgeon about the following considerations:
- What medications the patient is taking regularly and whether he or she should stop taking them before the procedure
- When to stop eating or drinking before an operation and if the patient should be on a specific diet in the days or weeks leading up to the procedure
- Why patients should remove nail polish and makeup before a procedure
- What devices or items a patient should bring on the day of the operation, such as a walker, and items that should be left at home
- Options regarding anesthesia or sedation
- Documents stating a patient’s advance directives
Things to know the day of the operation
The campaign also gives tips for patients to remember the day of the procedure, such as the following:
- Know what will be asked on the informed consent form
- Expect someone from the surgical care team to mark the location of the operation
- Ask the surgeon if the care team will take a “time out” right before the operation to ensure they are doing the procedure the patient agreed to undergo on the informed consent form
To assist in educating surgical patients, The Joint Commission launched a new Speak Up patient safety campaign in November 2020, which is focused on providing information on what a patient should know before and after an operation.
Recovering from surgery
Speak Up for Safe Surgery also provides the following advice on what a patient should know about the postoperative rehabilitation phase:
- Verify the dosage and frequency of new medications, as well as any side effects
- Inform the care team of any signs of infection
- Schedule follow-up appointments, get prescriptions for new medications, and follow the instructions in any discharge plans
Considerations during the COVID-19 pandemic
The infographic also features a section on special considerations patients should take into account during the coronavirus 2019 (COVID-19) pandemic, such as understanding the facility’s safety procedures, including the following:
- Wear a face mask or covering when entering the facility
- Cleaning and disinfecting protocols
- Personal protective equipment that will be used
- What the patient should do if a fever or cold symptoms emerge the day before the operation
As hospitals continue to meet the challenge of treating patients with COVID-19, it is possible that operations may shift to an ambulatory surgery setting to help alleviate some of the burden. If an operation is moved, the safety procedures and preparations that the care team carries out will remain the same.
About the Speak Up program
The Joint Commission established the Speak Up program in 2002, and program materials have been used in more than 70 countries to encourage patients to be their own advocates and to engage in the following activities:
- Speak up
- Pay attention
- Educate yourself
- Engage with advocates (family members and friends) who can help
- Know about your new medicine
- Use a quality health care facility
- Participate in all decisions about your care
To download Speak Up for Safe Surgery, visit www.jointcommission.org/resources/for-consumers/speak-up-campaigns/for-safe-surgery/.
The thoughts and opinions expressed in this column are solely those of Dr. Jacobs and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
*Forman R. Study finds many patients unaware of what the anesthesiologist actually does. MedicalXpress. January 23, 2015. Available at: https://medicalxpress.com/news/2015-01-patients-unawareanesthesiologist.html. Accessed January 6, 2021.
†Iannaccone FD, Patel S, Chinn LW. Patients’ pre-operative understanding regarding the role of anesthesiologists. New Jersey Medical School. October 13, 2014. Available at: www.asaabstracts.com/strands/asaabstracts/abstract.htm?year=2014&index=12&absnum=3025. Accessed January 6, 2021.