The Importance of Teamwork for Surgical Diagnostic Safety in Outpatients
RCSEd Communications Team
The Patient Safety Group (PSG) of the Royal College of Surgeons of Edinburgh (RCSEd) are delighted to lend our enthusiastic support to the sixth World Patient Safety Day (WPSD). This event, established by the World Health Organisation (WHO) in 2019, takes place on 17 September every year. It helps to raise global awareness amongst all stakeholders about key Patient Safety issues and foster collaboration between patients, health care workers, health care leaders and policy makers to improve patient safety. Each year a new theme is selected to highlight a priority patient safety area for action.
The theme set by the WHO for this year’s WPSD is “Improving diagnosis for patient safety”, recognising the vital importance of correct and timely diagnosis in ensuring patient safety and improving health outcomes.
Delayed, incorrect or missed diagnoses are a significant cause of poor outcomes for patients, their families and healthcare providers. The WHO World Patient Safety Day theme 2024, ‘Get it right, Make it safe’ highlights the vital importance of such diagnostic safety. Modern healthcare is a complex multi-disciplinary endeavour. Close teamwork is integral to providing correct, timely, well communicated and ultimately safe diagnoses for our patients. The importance of teamworking is emphasised with its own domain in the GMC’s General Professional Capabilities framework and human factors systems such as the Non- Technical Surgical Skills (NOTSS) system developed by the RCSEd and University of Aberdeen.
The drive to provide patients with exactly such safe diagnoses has prompted the development of investigative units or hubs. The Get It Right First Time (GIRFT) report in urology highlighted the increasing delivery of patient care in the outpatient or ambulatory setting, with a broad suite of diagnostic tests such as flexible cystoscopy, transperineal prostate biopsy and laser ablation of bladder tumour. These were historically provided in a multiple, disparate sites such as endoscopy units, theatres and outpatient departments requiring several patient visits. Such co-location is undoubtedly an aid to diagnostic patient flow, but the complexity of such working requires careful planning. Whilst investigative units focus on the patient-clinician encounter they have impact on the whole diagnostic pathway, from engagement to outcome. Pivotal to this is an effective team of healthcare professionals collaborating and working with patients towards shared goals of better outcomes.
Our own experience over many years of quality improvement in urology outpatient services has allowed us to develop novel ways of multidisciplinary working and informed the design of our urology investigation unit at Perth Royal infirmary, Scotland. The recognised benefits of a one-stop model of care provided by a multidisciplinary team in a dedicated investigation unit means that diagnosis is no longer the sole responsibly of a lone clinician but a team undertaking. The involvement of multiple professionals helps to mitigate the risk of cognitive bias or error that can occur if a diagnosis is made in isolation. Peer support and review, aided by ease of face-to-face discussion during the patient visit, further aid both diagnosis and learning. We have found that this supportive atmosphere aids professional development and encourages all staff groups to demonstrate their full competencies. This translates into a more efficient, safer diagnostic journey for patients.
Ease of communication between disparate team members is vital if we are to realise the full potential of the one-stop model. We begin each clinic session with a team safety huddle, in common with other settings such as operating theatres and wards. This allows introductions, review of each team members roles and verbal review of safety issues. This clarity of individual responsibilities helps in ensuring that the whole team have a shared understanding of ways of working and common goals. This huddle is led by the coordinator of the day, usually the lead clinic nurse. This nominated team leader, and coordinator also works as a visible and available point of contact for other team members throughout the day, reducing delays or miscommunication waiting for a specific colleague to be free for discussion.
The RCSEd leads initiatives to highlight the importance of human factors in surgical patient safety with NOTSS (Non-technical skill for surgeons) and training surgeons in these vital skills. The communication and teamwork skills within this framework have been extended to surgical ward rounds and have guided us in the development of strategies in the outpatient ambulatory setting.
Inclusion of the patient in the diagnostic process is known to enhance safety. The breadth of our team means that a range of professionals are available for patient discussion and counselling during the clinic visit. All patients with a suspected or proven new cancer diagnosis meet a specialist nurse before leaving the clinic. This ensures verbal and written information is passed to them, a greater understanding of the patient’s priorities is gained, and future communication facilitated by a single point of contact, known to the patient. To further reduce barriers in patient communication we also make use of video and telephone consultation. It is standard to address all communication, including the clinic letter, to the patient- a proven aid to diagnostic safety and reducing errors.
We have ensured that our clerical colleagues are based adjacent to the clinic as they are instrumental in facilitating patient contact. Another factor in multidisciplinary working is defined responsibility for result management and our administrative team perform an important role, in conjunction with IT systems and robust lines of responsibility, minimising missed or late reporting of results.
As the clinic involves multiple diagnostic modalities, a close working relationship with colleagues in laboratory medicine, radiology, pathology and oncology is fundamental. Whilst inter-departmental cooperation has been long established through bodies such as the cancer MDT, we have cooperated in all aspects of pathways run through the urology unit. This ensures safe, robust diagnostic pathways in, for example, prostate cancer biopsy but also novel pathways such as direct clinic review of all suspicious testicular masses; a next day appointment can be arranged directly from radiology and the patient given this information before leaving the ultrasound department.
Learning from errors is critical to patient safety. A functioning and dynamic team is well placed to take full advantage of learning from errors to make changes and enhance patient safety. We encourage all team members in use of standardised communication and reporting systems. Regular feedback at the daily patient safety huddle is complemented by more formal communication from the wider specialty clinical governance team when required.
We have recently relocated our clinic to a purpose-built area, but these ways of working were developed over many years, first in an endoscopy unit with three clinic rooms, then in a re-purposed ward area. The effectiveness of the system is not based on the physical space but made possible by a tight-knit, committed, multi-disciplinary team all working to common goals exemplifying how team- work with effective communication are crucial to safe, timely, and correct diagnosis for patients.
Written by Andrew D Martindale MA BM BCh FRCSEd (Urol.)
Consultant Urological Surgeon at NHS Tayside, RSA East Scotland and Educational Tutor, RCSEd
Similar Posts
- Together we can make a difference 23 October 2020
- Edinburgh Surgery Online - Patient Safety Programme 22 July 2021
- Mhairi Collie and the Uganda Childbirth Injury Fund 14 September 2021
- The Antenatal Clinic - Facilitating Safe Paediatric Surgical Care 15 September 2021
- Safe Maternal and Newborn Care in Relation to Oral Health 13 September 2021
Follow Us
