Patient safety during surgery: an explainer

Patient safety is one of the foremost healthcare concerns in the United Kingdom.

In England, the NHS defines patient safety as “the avoidance of unintended or unexpected harm to people during the provision of healthcare” – and it works to achieve this avoidance in a number of ways, including its:

• Patient safety strategy, which sets out a plan for continuous patient safety improvement.
• National Patient Safety Team and specialists, who deliver the strategy through various programmes and other areas of work.
• Support for providers, which aims to “minimise patient safety incidents and drive improvements in safety and quality.”
• National Patient Safety Committee, which addresses patient safety issues by bringing together key national healthcare organisations.

The significance of this work is staggering. The NHS estimates that empowering people – including both staff and patients – with the skills, the confidence, and the tools to improve safety can save almost 1,000 extra lives and more than £100 million in care costs every year.

But even so, problems can still arise during healthcare procedures – particularly high-pressure ones like surgeries and operations – so it’s important to understand where responsibility for patient safety ultimately lies, and what measures are in place to minimise risk.

Who is responsible for the patient during surgery?

During surgery, the primary responsibility for the patient lies with the surgical team. This team can be made up of several healthcare professionals who work together and share a duty of care to ensure a successful and safe procedure.

According to the Royal College of Surgeons of England, this team can include:

• A consultant surgeon who is responsible for managing patient care, but may not perform the operation itself.
• Associate specialist surgeons, who work under the supervision of the consultant surgeon in both the operating theatre and outpatient clinic.
• Specialty surgeons, also known as staff grade surgeons or career grade surgeons, who can perform a range of operations and outpatient consultations under the supervision of the consultant surgeon.
• Specialist surgical registrars or specialty surgical registrars, who are in training to become surgeons and consultants.
• Core training doctors, formerly called junior surgical trainees, who are working to gain experience performing different surgical procedures.
• Foundation doctors, who are newly trained doctors on a required surgery placement.

The surgical team will also work with other healthcare professionals, such as nurses, anaesthetists, technicians, and other support or medical staff. These professionals are similarly responsible for ensuring patient safety during surgery through activities such as:

• Preparing the operating room.
• Sterilising equipment.
• Monitoring the patient’s vital signs.
• Providing support to the surgeon.

Communication and collaboration among team members are vital for good surgical care and preventing medical errors.

Problems that can arise during surgery

Despite the best efforts of medical professionals, problems can still arise during surgery. Some of the issues that may occur cannot be predicted or prevented, such as adverse reactions to anesthesia or medications. But if the issue is preventable, this is known as a surgical error, adverse event, or – within the NHS – a Never Event. 

The NHS has a number of defined Never Events, such as:

• Wrong-site surgeries. A wrong-site surgery is an invasive procedure that’s performed on the wrong patient, the wrong body part, or at the wrong site (such as the wrong knee, eye, or limb).
• Foreign objects left in the body. Also known as “retained foreign object post procedure”, this Never Event occurs when items such as swabs, needles, instruments, or guidewires are left in a person’s body post-surgery.
• General events. A general Never Event includes incidents such as falls from poorly restricted windows, chest or neck entrapment in bed rails, or transfusion of incompatible blood types.

“Never Events are patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers,” the Never Events policy states. “Each Never Event type has the potential to cause serious patient harm or death. However, serious harm or death does not need to have happened as a result of a specific incident for that incident to be categorised as a Never Event.”

Potential consequences of compromised patient safety

Patient injury or death

In cases where patient safety is compromised during surgery, patients may suffer anything from a personal injury, such as nerve damage, to life-changing side effects and even death. 

Surgical error claims

There can also be financial or legal repercussions for healthcare providers in cases of alleged medical negligence or malpractice. For example, legal avenues such as medical negligence claims and medical malpractice claims mean that injured patients – or their family members – can work with solicitors to seek compensation following surgical negligence, an unnecessary surgery, or a wrong procedure.

Measures for ensuring patient safety

There are a number of ways that healthcare systems and professionals can safeguard their standard of care and minimise risks to patient safety.

These can include:

• Adhering to processes. For example, conducting preoperative assessments and verifying the patient’s identity can help prevent wrong-site surgeries or procedures.
• Communicating effectively. Communication among healthcare professionals is essential for patient safety. Having a clear and concise information exchange helps prevent misunderstandings, reduces the risk of errors, and enhances coordination among team members.
• Continuous training and development. Medical professionals undergo rigorous training to acquire and maintain their skills and knowledge, but continuing education programmes ensures that staff stay updated with the latest advancements, best practices, and safety protocols.
• Maintaining robust records. Accurate and detailed medical records are crucial for patient safety. Comprehensive documentation helps track a patient’s medical history, surgical details, medication administration, and other essential information, ensuring continuity of medical care.

And within the NHS, patient safety is becoming more of a team effort:

“The mistaken belief persists that patient safety is about individual effort. People too often fear blame and close ranks, losing sight of the need to improve. More can be done to share safety insight and empower people – patients and staff – with the skills, confidence and mechanisms to improve safety,” it states in its patient safety strategy. 

To address this, the NHS is focusing its efforts on continuously improving patient safety, building a patient safety culture, and implementing a patient safety system.

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