The new president of the Royal College of Surgeons, Prof Frank Keane, today will launch a WHO initiative aimed at making surgery safer, writes Theresa Judge
A NUMBER OF new initiatives should help protect patients from errors during surgery and from the risk of infection, according to the new president of the Royal College of Surgeons in Ireland (RCSI).
Prof Frank Keane, a consultant in general and colorectal surgery who took up the position last week, will today launch a new World Health Organisation (WHO) initiative called Safe Surgery Saves Lives. It will also be launched in many other countries over coming weeks.
He said the RCSI was endorsing the programme developed by the WHO and hoped it would be implemented in hospitals throughout the State.
"This is not rocket science and in fact it is nothing that we haven't already been doing - what it involves is enshrining a number of steps that you have to do when you do any procedure," he said.
Prof Keane said he believed most mistakes were the result of a failure of communication arising "in the rush and bustle of surgery".
"Mistakes occur when there isn't enough communication - it is usually human error."
Prof Keane said it was recognised by the WHO that the problem needed to be tackled worldwide.
"This is not an Irish problem - it is an international healthcare problem and that is now recognised by the WHO."
One of the most high-profile surgical errors in Ireland occurred recently at Our Lady's Hospital for Sick Children in Crumlin when the wrong kidney was mistakenly removed from a sick child.
Safe Surgery Saves Lives gives surgical teams a checklist of steps that must be worked through, and the completed checklist must then be signed off.
Prof Keane said it covers communication between surgeons, anaesthetists and nurses so that everybody is clear about what is to be done, with critical points of the procedure highlighted in advance.
Other items on the checklist include the marking of the side of the body to be operated on, and a requirement to have all X-ray and blood test results in the theatre during surgery.
According to the WHO the Safe Surgery Saves Lives initiative "aims to reinforce established safety practices, and many of the steps are already accepted as routine in facilities around the world".
It adds: "It also aims to foster better communication and teamwork among clinical disciplines. The checklist is intended as a tool for use by clinicians interested in improving the safety of their operations and reducing unnecessary surgical deaths and complications."
Prof Keane said that although it would be the responsibility of hospital managers to implement the checklist system and that it would require the agreement of consultants and nurses, he suggested that staff might regard it as in their interest to complete the checklist and have it signed off.
"There is an element of 'carrot and stick' about this - for example, it might be a problem if the checklist is not done and a problem arises," Prof Keane said.
He said the RCSI was also developing another safety initiative called Best Practice in Surgery to Minimise Infection. This was focusing on identifying the causes of infection in surgery and on recommending steps to prevent it.
Prof Keane will serve as president of the RCSI, which is a non-profitmaking organisation, for two years. He said one of the aims of his presidency was to improve communication between surgeons and the public. He has been in his current position in Tallaght hospital since 1982, and before that worked in the UK and in the Mayo Clinic in the US.
He has been a member of the council of the RCSI since 1998 and has served on a number of surgical practice and training bodies in Ireland and internationally. He has received a number of awards and is an associate professor of surgery at Trinity College, Dublin.
The RCSI is involved in undergraduate training of doctors, in addition to surgical training. Under the new Medical Practitioners Act, the RCSI will also be working with the new Medical Council in developing a competence assurance system for surgeons.
Prof Keane said the priority was to provide reassurance to patients that surgeons would have up-to-date skills and offer a good quality service. The structures, which will be set up over the next two years, will be an audit system with outcomes and results monitored, he said.
Implementation of the National Cancer Control Strategy will also have an impact on the work of surgeons over the next two years and, while the RCSI is fully supportive of the strategy, Prof Keane said there was "an obvious concern" that you can't change cancer services without impacting on other services. With extra cancer activity in some hospitals, other services would be affected.
The RCSI has had meetings with Prof Tom Keane, who is in charge of the cancer strategy, and he gave reassurances that adequate resources would be provided, but it was "something we will have to keep an eye on," Prof Frank Keane said.
As a consultant in colorectal surgery, he is obviously aware of people's concerns, particularly since the death of Susie Long, about waiting times for colonoscopies and inadequate resources in this area. He said that there are no national figures for waiting times for colonoscopies and reports of long waiting times are anecdotal.
However, he added: "There is a concern that in individual cases people seem to be waiting inordinately long times . . . I do think that waiting times could be shortened."
The RCSI is working with the National Cancer Registry on an audit of colorectal cancer services in 2007. This will examine the treatment people received after diagnosis, he said.
While public awareness of colorectal cancer has improved, he said some people were still leaving it too late to seek treatment. "I still come across cases where you are astonished that people don't present sooner."
A new RCSI national surgical training centre should also be open by the end of Prof Keane's time as president. In the meantime, work continues on developing training programmes at the St Stephen's Green site. He said the RCSI was proud of its record in surgical training and was at "the cutting edge internationally".
Much of this work was based on the principle that it is better to do as much training as possible outside of the operating theatre, he said.
A number of innovative training methods have been devised to allow trainee surgeons practise such skills as stitching, tying knots and joining arteries, veins and intestines, he said. Some of these involve using computerised simulators.
"We also have a mobile skills unit - the only one in the world - that is basically a lorry that tours around the country and parks in hospital car parks where local trainees can come out and learn the skills from local consultants. We are looking at more and more ways that people can practise and develop their skills."
He said there were even take-home kits that trainees could use to practise surgery skills. A kit that has been developed by an RCSI professor consists of a camera, a box and a number of instruments that can be connected to a TV or monitor to allow trainees practise key-hole surgery skills.
Prof Keane stresses that in addition to its work in Ireland, the RCSI is also working on a number of surgical training projects abroad, both in the Middle East and in Africa. In Bahrain, the RCSI is also developing an undergraduate medical school.