Finding the Problems Before Fixing Them: The Culture of Perioperative Safety:   Comment on “A Systematic Quantitative Assessment of Risks Associated With Poor Communication in Surgical Care”

Although some may argue about the exact number of Americans who die or experience preventable complications as a result of the delivery of health care, all stakeholders are in agreement that there are opportunities to improve the safety of health care delivery and to reduce errors. Only recently has there been objective assessment of the specific points in patient care that are susceptible to error; failure of communication in the perioperative period has been implicated as one of the most significant causes of errors (real or potential).^1- 2 In response to this, many have adapted and subsequently adopted checklists and resource management principles from the aerospace industry, in which flight safety has clearly been shown to improve adherence to standardized protocols and communication training.³ Nagpal et al used the HFMEA tool to evaluate specific points in the delivery of surgical health care that are prone to errors. This process was labor intensive and will not be generalizable to all patients, procedures, or health care environments. However, we now have the opportunity to quantitatively evaluate interventions directed toward improving safety before actual harm comes to the patient.