Some reference information about Current status of medical incidents in surgery

1. Status of medical incidents in surgery in the world

According to a report by the World Health Organization (WHO), each year there are approximately 230 million PT cases worldwide. Complications endanger the lives of 7 million people, including nearly 1 million deaths related to surgical safety (ATPT), nearly 10% of fatal complications occur in operating rooms. big. For every 150 hospitalized patients, there is 1 death due to a medical incident and 2/3 of the incidents that occur in the hospital are related to PT.

Recent reports show that PT-related incidents occur at a higher rate in developing countries. Pathologies requiring surgical intervention are increasing due to: increased cardiovascular disease, increased injury accidents and many people with trauma, cancer, increased life expectancy,... and thus, the risk of incidents occurring or medical errors related to PT are also increasing.

During a cesarean section, the risk of newborn injury is about 0.7% - 2%. Errors: "Cut the mother - cutting the wrong baby" (skull, forehead, buttocks, thighs,...), breaking the arm, dropping the baby causing death, cutting the woman's bladder,...

ATPT incidents are strictly managed by developed countries and reported in many specialized journals and especially the magazines Patient safety/Lippincott Williams & Wilkins (since 2005), Patient safety in surgery/LWW (since 2005). 2007), is a good forum to report, exchange and learn about ATPT.

However, 'The facts that we know are actually much lower than reality.

2. Status of medical incidents during surgery in Vietnam

In Vietnam, many medical incidents related to PT still occur. Typically, some cases have been reported by the media recently:

1) The case of 21-month-old baby Tran Anh D., whose bladder was mistakenly cut during inguinal hernia surgery in 2012 at Cam Ranh City Hospital, Khanh Hoa province.

2) Case of surgery on the wrong leg at Viet Duc Hospital in 2016.

3) Case of surgery on the wrong hand at Hospital 115 Nghe An in 2016.

4) Having lost one kidney, the doctor at Can Tho General Hospital "accidentally" removed both on December 6, 2011.

5) Patient Ma Van Nhat (Bac Can) was left with a pint in her stomach by Bac Can General Hospital since 1998, and it was not discovered until December 2016.

At Central Military Hospital 108, there were also a number of errors that caused serious consequences. Success - failure reports over the past 3 years (2014 - 2016) show an average of 9 failed cases/year. The causes that have been pointed out include:

- Not closely monitoring the patient, patient handover is not specific and clear

- Recording medical records is not careful or accurate. Brief summary of the surgery.

- Failure to promptly report to superiors, failure to invite consultation when encountering difficulties or unusual developments. Slow and indecisive emergency care.

- Inappropriate patient selection and surgery timing.

- Poor pre-operative preparation.

- Poor surgical technique (bleeding, wrong cutting, damaging healthy organs, not understanding new techniques,...).

- Lack of experience so we cannot detect and evaluate all damage and cannot predict the progression of the disease.

- Prepare missing PT tools,...

3. Solutions to ensure patient safety during surgery

3.1. General solutions to prevent medical incidents in surgery

- General views on preventing medical incidents:

+ Needs to be considered as a global public health issue.

+ Responsibility not only for each individual but also for the entire health system (from hospitals to the health sector, health-related policies).

+ Need to strengthen incident research, deploy incident reporting system,...

- General solutions to limit medical errors and incidents in PT:

+ Create a culture of safety: Errors and complications must be considered as learning opportunities for the future. Medical staff need to courageously disclose complications for colleagues to refer to on forums.

+ Improve error collection and measurement: Information about common errors that recently occurred is the only opportunity to effectively improve ATPT performance. Reported complications and deaths account for only a small percentage of the actual rate.

+ Follow a systems approach.

+ Identify issues that need to be prioritized for resolution.

+ Be cautious when pioneering new techniques.

+ Accept the obligation and limit mistakes.

- Main contents to prevent surgical incidents:

+ Relevant medical staff need to clearly understand information about the patient.

+ Prepare carefully before each PT shift.

+ Connect the surgical team (operator, anesthesiologist, nurse and assistant).

+ Human factors play an important role.

+ Hospitals and medical facilities should organize courses or seminars on medical errors and incidents to regularly remind medical staff.

+ Improve working conditions.

+ Have a regular and timely incident reporting system. In WHO's list of serious medical incidents that must be reported, incidents caused by surgery and procedures are at the top, including:

* Surgery at the wrong location on the patient.

* Surgery on the wrong patient.

* Wrong surgical method on the patient.

* Leftover gauze and tools.

* Death during or immediately after routine surgery.

3.2. Ten surgical safety goals as recommended by WHO

WHO has set out 10 main goals in implementing Safe Surgery:

1) Operate on the right patient, in the right surgical area.

2) Use appropriate pain relief methods to avoid harm to the patient.

3) Assess and prepare to effectively deal with the risk of airway obstruction and respiratory function.

4) Assess and prepare well to handle the risk of blood loss.

5) Avoid using allergenic items or drugs in patients known to be at risk of allergies.

6) Maximum application of methods to minimize the risk of surgical infection.

7) Avoid leaving surgical instruments or cotton swabs in the surgical area.

8) Carefully check and compare PT specimens.

9) Notify results and exchange information with ATPT implementation organizers.

10) Hospitals and health systems establish departments tasked with regularly monitoring the number and results of PT.