Lean Can Improve Fire Safety in Operating Rooms

I suspect most people don’t normally think of fire as something you should worry about when you go in the hospital. But apparently it is – and I believe it is also a problem that could be a prime opportunity for applying lean principles.

According to an article in The Wall Street Journal, the risk of fire occurs primarily – though not exclusively – in the operating room “because high-tech electrosurgical tools and an oxygen-rich atmosphere can create a combustible mix.” But there have also been reports of fires related to everything from the coils in MRI machines to bassinet warmers. Some patients have suffered severe burns.

While there is no national database of hospital fires and burn incidents, data from studies conducted in Pennsylvania indicate there are 650 surgical fires in hospitals annually in the U.S. -- and there may be three to four times as many "near miss" incidents, such as a surgical drape that begins smoldering and was extinguished quickly, says John Clarke, a trauma surgeon and clinical director of the Pennsylvania Patient Safety Reporting System. While a surgical fire is a relatively minor risk compared to infection, the fact that fire is "preventable and can have such serious repercussions for patients elevates its priority", Dr. Clarke says…

One analysis of closed malpractice claims by the American Society of Anesthesiologists shows that of 145 claims for burn injuries, more than half were from devices intended to warm the patient, while 31% were from electrical tools used for cauterization.

Many hospital workers are unaware of their hospital’s fire-safety guidelines, don’t know about many burn hazards and haven’t been trained in fire prevention.

Training in proper use of equipment and prevention methods is important, of course. But there is more to it than that.

Hospitals are also stressing the importance of teamwork in the operating room, where surgeons wield the heat sources, nurses and technicians dispense the disinfectants and ointments that can act as fuel, and anesthesiologists administer oxygen and nitrous oxide. Because each member of the team may be focusing on his own role in a procedure, "the No. 1 cause of fires is lousy communication" says Patricia Seifert, editor-in-chief of AORN Journal, the monthly publication of the Association of periOperative Registered Nurses. AORN developed a fire-safety tool kit that it sent to 13,000 operating-room directors and managers around the country, and it is now offering the kit free to its 42,000 members.

Remember those recent news reports about how the use of surgical checklists can reduce complications? Something similar is probably applicable here. Call it standard work, or use of a cross-functional team, or mapping of a process – pick your own lean tool. But my point is that a lean strategy and use of lean tools are clearly one of the best approaches for addressing this problem.