Healthcare Regulations. Adherence?

How well do surgeons adhere to regulations?

Medical practitioners are entrusted with one of the greatest tasks there is: managing human health and guiding persons towards optimal health. Thus, the medical profession leaves very little room for errors. Medical professionals are meant to be very sure of every step they take towards the management of the health of a patient.

Although there is a general need for strict adherence to existing regulations across the different specialties of medicine, this need is particularly emphasized with surgeons. Surgery is a specialty that especially requires adherence to regulations. Surgical interventions are usually restricted to situations when they are necessary. Thus, these interventions should be carried out in the most efficient manner. The aftermath of invasive procedures on the human body is another reason why these procedures should be carried out only when they are absolutely necessary and should be done in the most efficient way. The changes that occur after surgery are usually permanent.

Surgeons are thus especially tasked with maintaining the best standards for every procedure adhering strictly to existing regulations. This article examines how well surgeons adhere to existing regulations highlighting misconducts that have been recorded over the years.

Why surgical misconduct occurs.

Research has established that, although medical lawsuits are common, lawsuits based on surgical procedures are the commonest in the US. The increase in these errors has been attributed to the trend of hospitals to ensure that patients go through surgery and recovery in the shortest time. This practice has been in a bid to improve the revenues of hospitals as well as making operations more efficient. Because of the reduction of the time patients that have undergone surgery spend in hospitals, more room has been for errors as due diligence may not be followed in a bid to save time.

It has also been established by research that the working hours of surgeons which exposes them to high levels of stress and could lead to burnout influences the occurrence of surgical errors as well as misconducts. There have also been allegations that surgeons with inadequate experience are sometimes tasked with surgical procedures increasing the tendency of misconduct.

It is particularly important to consider misconduct in surgeries because these misconducts result in major financial implications in addition to the additional stress on the health on the patient. If the error impacts the health of the patient, for example, subsequent corrective measures, which may be surgical will be needed. It is no news that the cost of healthcare is on the increase and the cost of specialty services is even higher.

Types of surgical misconduct.

Surgical misconduct occurs in different forms, and these misconduct could critically affect the quality of life of the patient. These errors have been categorized into those that should never occur and those that could be permissible.

Surgery on the wrong patient.

Surgery could be performed on a patient that doesn’t need that surgery, and this is an error that occurs in the hospital due to improper information flow. This mistake could be as a result of a mix up of laboratory results as well as other factors.

Surgery on the wrong site.

This is a very common surgical error. This form of error occurs when a procedure is carried out on a wrong site. A common example is the amputation of a wrong limb. Surgeries may also be performed on the wrong side of the abdomen as well as on the wrong lobe of an organ.

Surgeries on wrong sites may be attributed to the negligence of the surgical team as well as other factors. Measures for avoiding performing surgery on the wrong part or side of the body such as marking of the site that should be operated have been suggested and implemented in certain settings with mixed results. Marking of sites sometimes led to more confusion on whether the marked side of the body or the unmarked side was supposed to be operated.

Instruments left in the body.

As fictional as this may seem, surgeons still leave instruments in the body of patients after surgeries. To prevent the occurrence of incidences where instruments are left in the body of patients, certain measures have been implemented. These measures include counting of all surgical instruments before and after a procedure. This measure is not always followed and surgical instruments could be left within a patient without noticing.

Although other members of the surgical team such as the nurse could be blamed when instruments are left within the body of a patient, the blame ultimately falls on the surgeons who coordinates the surgery.

Apart from instruments, there have been reported cases of other surgical materials such as towels and sponges left within the body of a patient.

Accidental organ damage.

Surgeries are designed to be as minimally invasive as possible. Thus surgeons generally have to work within limited spaces and be as precise as possible. Otherwise, accidental damage to nearby organs may occur during surgery.

Delicate organs close to the site of a surgical procedure are especially prone to damage during the procedure. Thus, surgeons are expected to be especially precise with their movements to prevent damage to nearby organs with the scalpel and other surgical instruments.

Accidental damage to organs may not be commonly reported because the damage may not be linked to the surgical procedure. These damages, however, could result in life-threatening consequences.

Infection.

It is a basic regulation that surgical environments and instruments must be sterile. This regulation is pertinent because surgery exposes compartments of the body that need to maintain a certain constancy in their environment to the external environment. Thus, the environment of surgery shouldn’t introduce substances into the body of the patient that could compromise the internal environment.

The need for a sterile environment is also based on the fact that the immune system of a patient may be suppressed before a surgery making them especially susceptible to infection. The use of unsterile instruments especially exposes a patient to infections which may be life-threatening. Although infections arising after surgery could be as a result of other factors, contaminated surgical environments and instruments may be the cause.

Nerve injury.

A nerve could be mistakenly severed during surgery. Generally, nerves are bound to be severed during surgery, and the nerves that could be severed are communicated to the patient before surgery. However, further damage could occur when due diligence is not followed.

Surgical errors such as leaving an object within the body of patients are categorized under those that should not occur. Wrong site surgery is also categorized under surgical mistakes that should never occur.

Cases of surgical misconduct.

All over the world, surgical misconduct is recorded and regulations established to ensure that these regulations do not reoccur. However, surgical errors still largely occur. According to research, thousands of surgical mistakes, including those that are expected never to be carried out by a surgeon, still occur leading to settlements and legal cases within hospitals.

Some of the notable cases of surgical errors are highlighted below.

In the UK, in 2015, a female patient complained of abdominal pain and appendicitis was diagnosed. An appendectomy was then scheduled at the hospital that is under the management of Sheffield Teaching Hospitals Trust. At the end of the surgery, the patient’s appendix was still there while her reproductive organs were gone.

The surgeon mistook the reproductive organs for the appendix which he removed. The surgeon faced UK medical authorities and was banned from further practice as he had performed similar mistakes a short time ago.

In 2012, in Oakwood Hospital, Michigan, brain surgery was performed on an octogenarian that didn’t need the surgery. The patient visited the hospital because of a displaced jaw, and her examination included a CT scan, the source of the error.

The CT, which belonged to another patient, indicated bleeding in the brain, and emergency surgery was scheduled. On opening the patient skull and not finding any bleeding, the error was detected. The error was detected too late as the patient never regained consciousness and passed away about 2 months after the surgery she didn’t need.

There have also been reports of surgeons not adhering to the requests of patients during procedures such as breast enlargement. There is the case of a surgeon who gave a patient a bigger implant than the size she chose also making unnecessary sexual gestures during and after the surgery.

Surgical misconduct could be classified as errors, negligence or gross negligence. These categories of misconduct are distinguished by certain features. Misconduct could be negligence when a very preventable error occurs. A case where a blood vessel was severed in a simple surgical procedure could be treated as negligence since it could be prevented by applying due diligence. Errors in surgeries could be pre-surgery and during surgery. When a surgeon wrongly prescribes a procedure, it is a pre-surgery error. Errors such as severing of a major nerve such as the sciatic nerve is a physical error that could occur during surgeries. Occurrences such as performing surgery while drunk or sexual misconduct are classified as gross negligence since they disregard very specific regulations that apply to surgeons.

Hospitals make a lot of settlements yearly as regards medical errors, even the very preventable ones, and there’s a need to establish better regulations in curtailing the tendencies of surgeons to flout regulations directly or indirectly.

In all fairness to any healthcare professional, the actual number of opportunities that occur each day on the average patient is greater than 50.  With the number of 50 multiplied by the number of patients per year then divided by the number of errors that occur, the results are so minimally small in figures. It makes it impossible to see an issue or problem significant enough to warrant a major change in how most health care professionals work each day. But, because these are lives of living beings, each mistake is magnified greatly as much as 1000%, thus we must adhere to the smallest regulation, best practice, standard of practice as the humanitarian way of pushing ahead.