Dr Abel Samuel Raj Asirvatham, head of medical quality and safety function at Practo Care Surgeries (PCS), is designing a medical quality framework and clinical pathways for various surgical procedures that partner clinics and hospitals must adhere to. 

Patient safety has been the bedrock of healthcare, defined as freedom for a patient from unnecessary or potential harm associated with the provision of health care. However, there have been gaps in patient safety leading to adverse events. According to World Health Organization (WHO), the occurrence of adverse events due to unsafe care is likely one of the 10 leading causes of death and disability in the world– a grim reality that calls for a focused deliberation on patient safety. 

In surgery the stakes go higher. Being a dynamic speciality, any error in surgical procedures can have a catastrophic effect on the surgical outcome and the patient. A critical yet sparsely highlighted area, Dr. Abel Samuel Raj Asirvatham, Head of medical quality and safety function at Practo Care Surgeries (PCS), unfurls the complexities of surgical errors and provides a way forward. He has a rich experience in formulating many NABH policies for organisations and taking them successfully for NABH accreditation. Dr Asirvatham, as an NABH Assessor and its Joint Director, has also led many hospital teams for JCI accreditation across the country. Currently, he is designing a medical quality framework and clinical pathways for various surgical procedures that Practo’s partner clinics and hospitals must adhere to. 

What is the current status of patient safety initiatives in India?

Laws and regulations for healthcare quality and patient safety do exist in India, however, they are largely fragmented. Since accreditation is voluntary, only healthcare organisations that implement accreditation standards like NABH, JCI, and NABL, follow patient safety standards to an extent. Being a developing country with several inherent challenges, patient safety in India needs more focus and can highly benefit from implementation of stringent processes. 

What are some of the most significant Surgical Errors?

There are a number of things that can go wrong if proper protocol and due diligence is not followed before and after surgery. Here are a few of the surgical errors that should be avoided at all times:

• Taking patients for surgery without proper preoperative work-up and Pre-anesthesia checkup  (PAC) can lead to serious postoperative complications or even adverse events during the procedure.

• Conducting surgery on the incorrect section or side. For instance, a situation where the surgeon, instead of doing cataract surgery on the right eye as planned, does it on the left side.

• The wrong patient identification: A situation when a patient scheduled for surgery X gets surgery Y and vice versa. For example, a patient scheduled for a Haemorrhoidectomy instead, gets operated on for a cholecystectomy due to wrong patient identification.

• Leaving a piece of surgical equipment such as sponges, or instrument inside the operated site of the patient. 

• Anaesthesia toxicity: Administering high dose anaesthesia beyond the required levels, including inadvertent arterial and venous injections, can cause toxicity leading to postoperative and intraoperative complications.

• Procedure conducted by a doctor who is not credentialed or privileged to do that particular surgery. For instance, allowing a general surgeon to do a Lower segment Caesarean section (LSCS) procedure.

What absolute measures should healthcare organisations follow to ensure patient safety in surgery? 

The first step is to have a protocol for preventing adverse events during surgery like a wrong surgical site, a wrong patient, or a wrong procedure. It is crucial to adhere to the WHO safe surgery checklist, which is fundamental to preventing any adverse events before, during and after surgery. To ensure patient safety, organisations should follow these:

• Ensure the right patient is taken for the right surgery

• Only appropriately credentialed and privileged surgeons should be allowed to perform respective procedures.

• Ensure proper consent is taken from the patient/kin for the right procedure and technique before surgery

• Formulate and implement strict protocols to prevent adverse events.

• Ensure proper post-operative follow-up.

• Conduct periodic audits internally and through external bodies like NABH, etc.

How is Practo delivering quality secondary care and ensuring patient safety in surgery?

Practo has a ‘zero-tolerance’ policy towards any negligence arising from patient care. And for this, extra care is taken to implement a robust set of protocols and SOPs that all our healthcare partners need to follow. 

Credentialing doctors by their qualification, conducting a thorough evaluation of clinics and hospitals of all statutory and mandatory compliances, to carrying out an onsite assessment of the infrastructure, processes and clinical outcomes of clinics and hospitals—Practo’s 40-member strong medical team with 200+ years of experience (India and International)  oversees all operations, including Practo Care Surgeries and ensures quality at every touch point.  

A message for healthcare providers on Patient Safety Day

On this patient safety day, let us pledge to follow these seven rules to foster a culture of safety in our organisations:

• Lead and support your staff in patient safety initiatives.

• Follow the International patient safety goals.

• Promote adverse event reporting and learn from these errors rather than taking punitive action.

• Involve patients and the public in these initiatives

• Listen and support frontline workers like doctors and nurses.

• Implement solutions to reduce harm

• Finally, sustain the patient safety initiatives taken by your organisation.