MARCH 2004
Volume 28 • No. 3

'Boarding Pass', H&Ps crucial
to OR safety, efficiency, compliance

After feedback from physicians and other professionals, a six-month-old "Boarding Pass" process continues to be refined at Stanford Hospital operating rooms to guard against wrong site surgeries and other potential errors.

"The key to safety and efficiency is to listen to the people directly responsible, and as a result, early this year we streamlined our 'Boarding Pass' process to make it more effective at promoting patient safety as efficiently as possible," said Richard I. Whyte, medical director of operating rooms at Stanford Hospital.

"'The Boarding Pass', along with a complete and current H&P, are among the most important tools for patient safety," Whyte said.

He said the "Boarding Pass" was implemented last August to help audit one of the most crucial JCAHO (Joint Commission on the Accreditation of Health Care Organization's) National Patient Safety Goals for Correct Site Surgeries (NPSG #1 and #4).

The purpose was to complete a checklist - a "pass"- verifying all the required surgical prerequisites, including complete H&P, signed consent, as well as chart and labs were present, etc., for every surgical patient before patients could be "passed" into the OR suite for their procedures.

"We discovered during a pilot period that the original scenario proved to be a resource intense process with less than optimal compliance by the physicians and staff," said Joann Rickley, director of operating room services. "Moreover, the initial step had no vehicle for verifying and documenting the entire process.

"Discussion among the managers during the pilot period proved fruitful since, by the end of the year, the boarding pass was re-designed using two tools for documenting the entire correct site surgery process: 'Boarding Pass in the OR Region - Pre-Op' and 'Boarding Pass in the OR Region - Pre-Induction'. Both of these tools became part of the medical record, validating their value for compliance and documentation.

"Furthermore," Rickley explained, "the signature process was streamlined so that the most available member of a team - surgeon, anesthesiologist or circulating nurse - could sign immediately after the 'Time Out' [the mandatory OR validation of patient/surgery/ site].

"Doctors, nurses and administrators have been working to improve operating room policies to ensure not only safety, regulatory compliance and efficiency - but also to support physician needs and preferences," said Whyte, a cardiothoracic surgeon.

Perhaps central to patient safety and OR efficiency, Whyte said, is the H&P, a centerpiece of the "Boarding Pass" routine.

"Basically, it's frustrating to stop work and wait or search for information that should be readily available at a time when all our skills and intellect should be directed at the task at hand," said Whyte. "Essentially, all members of the team should begin making sure that this information is readily available, starting from the patient's first office visit, and if this is the case, the monitoring that occurs during the 'Boarding Pass' checkoff should be relatively seamless."

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