25 May 2016
Surgical services are an essential part of healthcare. Worldwide and in Palestine especially, traumatic injuries caused by home accidents or inflicted by violence, cancers and cardiovascular diseases are continuing to increase, leading to the growth of surgical intervention. Surgical horror stories, where patients receive the wrong operation or have the wrong limb removed, are not just urban legends. Where such cases occur, adequate reporting is limited as health professionals fear repercussions. The World Health Organisation (WHO) has therefore designed a surgical safety checklist and an implementation manual to ensure the best outcomes for patients. By following the WHO’s instructions, the most common risks to patients can be minimised and lives saved.
Currently, the WHO’s manual is not systematically applied in any of the Ministry of Health facilities in Palestine, though many of the steps are already accepted as routine practice. Further, training for staff working in operating rooms is very limited.
In January 2016, MAP launched a new project together with Juzoor for Health and Social Development and the Palestinian Ministry of health (MOH) to enhance perioperative care in the West Bank by introducing the WHO’s surgical safety checklist and standards. The project will develop the capacity of all health professionals working in operation rooms in all 13 MOH facilities with operation rooms through training.
Founded by a team of health professionals, Juzoor is dedicated to improving the health and well-being of Palestinian families and promotes healthcare as a basic human right. Marina, program coordinator for Juzoor, knows from her own family’s experience how important this project will be to improving the health of all patients undergoing surgery: “A couple of years ago, my son had to undergo surgery for a hernia,” she told MAP. “He was rolled into the operation room and I was waiting nervously outside. After some time, the surgeon poked his head out of the operation room and asked me ‘is the hernia on the right or on the left side?’”
“There is no documentation system but we are sure there are many stories like this one. The doctors we met so far showed a lot of enthusiasm and they want to participate to improve their services. An improved health information system will lead to improved quality. We hope we will build capacity and contribute to an increased survival rate.”
The safety checklist aims to reduce safety issues, including inadequate anesthetic safety practices, and poor communication among team members leading to death, blood loss, pneumonia, infection and disability among other complications. These issues are common, deadly and preventable globally. Furthermore, they are devastating to patients and costly to health care systems like the Palestinian, which is already under pressure.
Since the WHO introduced it in 2008, the use of the Surgical Safety Checklist has been mandated in operating rooms in over 4130 hospitals across 122 countries. Studies in developing countries suggest a death rate of 5–10% associated with major surgery. When the WHO checklist was trialed across eight pilot hospitals internationally, deaths and surgical complications reduced by over one third. Nevertheless, with the exception of Jordan, the checklist is barely used in the MENA region.
Through MAP’s support Palestine is set to become a pioneer of surgical safety best practice
Since the project launched in January, MAP and partners have held a meeting to discuss how the adapt the tools to the Palestinian context, and identified key persons in each of the 13 MOH hospitals who will be responsible for implementation. We have also provided these hospitals with a toolkit for beginning this work, including the checklist, the manual, and 10 standards for effective implementation.
Dr Emad Hijawy, head of quality inside MOH hospitals, expressed why this project is so critical:
“Thanks to MAP’s support, we will be able to address one of the biggest challenges for us and an issue of huge importance. On a monthly average our hospitals carry out around 2000 to 3000 surgeries. In about 20% of the operations, the surgeon use some kind of check list, but this is not unified.This project will help us to launch a unified consent form for patients. The main goal is to reduce mistakes even before the operation takes place.”
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