Area hospitals sign on for safe surgery program

YAKIMA — Next time you go under the knife, ask the hospital if it uses a checklist when performing surgery.

The common-sense idea of ticking off a checklist -- much like pilots do before takeoff -- has come to Yakima County, where all four hospitals now participate in the voluntary program developed by the University of Washington Medical Center.

The checklist is part of an ongoing statewide effort by hospitals to reassure patients they're getting high-quality -- and safe -- care.

It comes at a time when the idea of transparency is sweeping the entire health-care system. Medicare, for example, is moving to a payment system that rewards or punishes hospitals and physicians based on their clinical performance.

The surgical program was first developed by the World Health Organization, which picked the University of Washington as the first pilot project in the United States.

Ultimately, the plan is to erase doubts about whether surgeries here are handled differently at big-city hospitals. In other words, the results of an appendectomy in Yakima shouldn't be much different from one performed in Seattle.

Yakima Regional Medical and Cardiac Center became the most recent facility to agree to participate in the program, known as Surgical Care and Outcomes Assessment, or SCOAP for short. UW officials visited the hospital earlier this week to confirm its participation, making it the 40th hospital in the state to join with about 20 more to go.

Toppenish Community Hospital -- owned by the same company as Regional -- will also participate. Yakima Valley Memorial Hospital joined two years ago.

The checklist component tends to attract the most interest from patients, according to UW doctors who developed the program.

It's a poster-sized board placed in the operating room with a list of precautions to be taken before, during and after surgery. Many hospitals hang it from the patient's intravenous pole so medical staff can see it, said Dr. David Flum, a UW gastrointestinal surgeon and outcomes researcher.

In a telephone interview, Flum said the checklist will improve patient safety, help avoid infections and increase communication among members of the surgical team by making sure proper practices are being followed. Traditionally, surgeons acted as the "coach," giving orders to the team.

Surgeons still need to lead the team, but "all members of the team are empowered to speak up," Flum said.

For instance, one guideline suggests that members of the surgical team identify themselves and ask simple questions like, "Does everyone agree that this is Patient X, who is having a hernia repaired?"

Other recommendations call for giving an antibiotic within 60 minutes of making an incision, checking for drug allergies and counting sponges and needles to make sure none are left in a patient.

Sheila Robinson, quality management coordinator at Sunnyside Community Hospital, which adopted the checklist guidelines about two years ago, said they have improved patient care.

For example, appendicitis is difficult to diagnose for various reasons, so the appendix is sometimes removed unnecessarily. At Sunnyside, patients with suspected appendicitis now consistently receive a Computerized Tomography (CT scan) in addition to other more routine blood and urine tests to aid in diagnosis. As a result, the number of appendectomies has gone down.

"This makes sure that every practitioner, every surgeon, nurse, radiologist and everyone in the ER all practice consistently," Robinson said.

Kathy Whitener, Yakima Regional's vice president for risk and quality management, said that while the hospital already had its own checklist procedure, the UW assessment program will allow surgeons to share best practice.

"Surgeons are data driven and they're excited to start this. From the hospital's standpoint, the more we can standardize things the more we can reduce errors and variability."

• Leah Beth Ward can be reached at 577-7626 or lward@yakimaherald.com

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