I thought of the pilot and his crew, the cabin crew attendants and the passengers, and how scared and worried they would have felt. On a flight, the attendants will take us through the safety procedures before take off. We are all guilty, I am sure, of partly listening because it is routine and we have heard it all before. Then suddenly we are in the midst of a violent storm and we need to utilise that information! We ardently listen to the attendants instructions and pray for the captain to land the plane safely, which he does with great skill!

I now want to link this scenario to the care of our patients in the operating theatre. They are also on a journey to a destination of a safe recovery and they depend on the consultants and the team to get them there safely. 

Despite being routine, we need to do all the safety checks for each patient and follow the WHO Surgical Safety Checklist as it is written: ask all the questions, involve all members of the surgical team, even do the fire risk assessment score if it is implemented in your theatre.

The pilot of that flight during Storm Dennis certainly did not think he was on a routine flight. He had a huge responsibility for the lives of his crew and many passengers!

We can only operate on one patient at a time. Always remember, even though the operation may be routine for us, it may be the first time for the patient – so let's make it a safe journey for each patient.

Do it right all the time!

The report makes 17 recommendations, including:

• developing formal 'hub' and 'spoke' networks.
• reducing the time to treatment for vital surgical interventions.
• improving perioperative and follow-up care.

Short video summary of the report

• optimising outpatient services.
• improving patient experience and reducing length of stay.
• placing a greater focus on urology emergency care.
• better networking between urology departments.

Following the report, GIRFT published a handbook for urology departments, Getting It Right in Urology handbook: innovations, good practice and guidelines for establishing a urology area network

Short video summary of the report

1. Tell them about your previous surgeries, anesthesia and current medications, including herbal remedies.

2. Tell them if you are pregnant or breast-feeding.

3. Tell them about your health conditions (allergies, diabetes, breathing problems, high blood pressure, anxiety, etc.).

4. Ask about the expected length of your hospital stay.

5. Ask for personal hygiene instructions.

6. Ask them how your pain will be treated.

7. Ask about fluid or food restrictions.

8. Ask what you should avoid doing before surgery.

9. Make sure that the correct site of your surgery is clearly marked on your body.

After surgery

1. Tell them about any bleeding, difficulty breathing, pain, fever, dizziness, vomiting or unexpected reactions.

2. Ask them how you can minimise infections.

3. Ask them when you can eat food and drink fluids.

4. Ask when you can resume normal activity (e.g. walking, bathing, lifting heavy objects, driving, sexual activity, etc.).

5. Ask what, if anything, you should avoid doing after surgery.

6. Ask about the removal of stitches and plasters.

7. Ask about any potential side effects of prescribed medications.

8. Ask when you should come back for a check-up.

1 Establish structured senior support

This can be done by re-establishing the team structure with consultants at the forefront of the delivery of care. Time should be made for safe handovers and structured ward rounds, utilising every opportunity to train. Finally, opportunities should be identified each day when Foundation Doctors and Core Trainees can contact seniors to discuss problems.

2 Reintroduce the hospital mess

It is important for doctors to have a protective environment in which they can unburden themselves and socialise with colleagues across the specialties. A hospital mess reduces staff isolation and enhances a sense of community within the working environment.

3 Intelligent design of rotas

Continuity of patient care, safety and a symbiosis between service and training must be integral to rota design.

4 Streamline and reorganise the overall workload to prioritise core clinical duties and create an integrated multidisciplinary surgical team

Systems and staff (medical and non-medical) could be organised more efficiently to allow doctors to dedicate the maximum amount of time to the clinical responsibilities most relevant to their grade. Where appropriate, consideration should be given to developing the extended surgical team to enhance the continuity and delivery of safe surgical care.

5 Recognise that better training delivers better care

Educational supervisors must be supported to deliver training through protected time in job plans.

But training can also benefit from the merging of tiers within training and maximised training opportunities during the day. It is also important to use training to develop and invest in the multi-professional workforce.

6 Promote human factors training

The profession must embrace a safety-centred team approach from the early stages of medical training.

7 Support and Training the Trainers

Trainers should be supported to plan, manage and focus on training at a local level, while having the opportunity to develop their faculty through formal activities such as ‘Training the Trainers’ courses and informal activities such as developing enhanced mentorship programmes for trainees and consultants alike.

Improvements were observed in safety climate, teamwork climate, and nurse turnover rates on a surgical inpatient unit after implementing a safety programme. As part of the CUSP process, staff described safety hazards and then as a team designed and implemented several interventions.

CUSP is sufficiently structured to provide a strategy for health care organizations to improve culture and learn from mistakes, yet is flexible enough for units to focus on risks that they perceive as most important, given their context. Broad use of this program throughout health systems could arguably produce substantial improvements in patient safety.

Cutting into the body, removing tissue and implanting a new joint or other prosthesis will always carry risks – especially as the patient cohort becomes increasingly complex with more co-morbidities. Hospitals and surgical teams want to reduce those risks as much as possible.

But what needs to be done to reduce the risk of infection – both in terms of clinical practice and in areas such as procurement?

An HSJ roundtable went looking for answers. The discussion included buying equipment which was best value rather than just the cheapest option, the use of data, educating health professionals and behaviour and culture.