Low-tech approaches to improving surgical results, from the Harvard Men’s Health Watch

Like other areas of medicine, advances in surgery are often driven by technology; laparoscopic hernia repairs and robot-assisted radical prostatectomies are just two of many examples. But high-tech innovations aren't the only way to make progress, as evidenced by the recent efforts of doctors who are developing some low-tech, low-cost ways to improve care. The July 2011 Harvard Men's Health Watch discusses three of these, which introduce simple interventions before, during, and after operations. The first study looked at the effect of having doctors warm up before surgery, similar to the way an athlete warms up before a game. Some of the doctors being studied were asked to perform warm-up exercises that mimicked the motions used in minimally invasive surgery before being tested on surgical simulators, while others were tested without warming up. The warm-up exercises appeared to improve both manual dexterity and mental focus. The researchers concluded that short-term preoperative warm-up exercises can improve both surgical proficiency and cognitive arousal (mental concentration). In the second study, researchers evaluated the use of a checklist to reduce surgical errors and complications. The checklist contained 19 items divided into three stages: a sign-in phase before anesthesia is administered; a time-out phase during a mandatory pause before the first incision is made; and a sign-out phase completed before the patient leaves the operating room. During each stage of the checklist, all items are verified aloud and confirmed by each member of the team. Researchers compared the clinical outcomes of adult patients whose operations used the checklist with patients whose operations did not. The checklist was highly effective, reducing deaths by 47% and in-hospital complications by 36%.
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