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A SafeStart to One Man's Journey - The Nursing Perspective

Nursing Perspective

By Katherine Lee, RN, BSN, CPHRM, CMPE

In our last blog post, we outlined a malpractice case. Today, we continue with the series by hearing a nurse's perspective on the problem.

Nurses in the hospital or ambulatory surgery center rely on accurate communication and upstream handoff from the surgeon’s office. Consistent documentation and communication of the surgical plan among all members of the surgical team, including the patient, is vital to enhancing the safety of surgical procedures. A single tool that follows the surgical process from the initial consultation through the surgical procedure allows for a seamless transition between care providers and locations. With today’s digital technology, reliance on faxed surgical consents and physician order forms is antiquated and increases the risk that documents will be lost, or surgeries scheduled incorrectly. The facts of this malpractice case exposed a potential deficiency in the current site verification process that contributed to the patient’s allegations of wrong-site surgery and a cover-up.  SafeStart is a novel digital patient safety solution that follows the patient through the surgical experience. Using its robust photographic documentation process, patient images, documents, and diagnostic results are available to all members of the team at any point in the process. In addition, the patient’s involvement in confirming or rejecting the surgical plan provides an additional layer of affirmation to the plan and allows the patient to be an active participant. Being able to access the patient’s SafeStart account and confirm the surgical plan is vital in preventing wrong-site surgeries.

SafeStart’s Patient and Clinical Engagement process

Let’s apply SafeStart to each step of this patient’s journey starting in the office. Using the SafeStart application the nurse takes a photograph of the intended surgical site in the anatomical position and the surgeon annotates it. The annotated photo of the intended surgical site, along with photos of all of the paper documentation, such as the surgical order form and consent forms, are uploaded to the SafeStart secure server. SafeStart sends an email with a login link to access the patient’s portal account. In the portal, the patient can view the surgical plan and the annotated photograph of intended operative. 

From home the patient can approve or reject the surgical plan. Also, the patient can review the listed allergies. If anything appears to be incorrect or if the patient has a question, the patient can reject the surgical plan. SafeStart notifies the clinic of the rejection. This allows timely follow up by the nurse with the patient, either correcting an error or clarifying the plan with the patient and the surgeon. Once the patient approves the surgical plan, it is time-stamped, and an acknowledgment is forwarded to the surgeon’s office. The confirmation is simultaneously shared with the surgical facility, reducing the risk of a scheduling error due to poor communication handoff, or human error. For LS, the facility nurse called the day before surgery to review the procedure over the phone. With SafeStart, that conversation can include both participants synchronously looking at SafeStart documentation to review the consents, allergies, submitted documents, and the photographs providing yet another opportunity for the patient to ask questions and confirm the plan.

On the day of the surgery, the pre-operative nurses access SafeStart to review the surgical plan and procedure site using the photographs with the patient and both sign off on the review process. This assists the nurse with authenticating that the patient agrees with the surgical plan. It also allows the entire surgical staff to review the same information. Before the first incision is made, the operating room team uses SafeStart to complete their patient specific time-out and verification process.  In the case of LS, had SafeStart been used, the patient would have reviewed the operative site and signed off on the final plan before reporting to the surgery center. This adds another layer of documented visual image confirmation to augment the usual verbal process conducted in the preoperative holding area. Postoperatively after discharge from the facility should the patient have questions about the procedure performed, the documents and photographs that were used during the SafeStart Timeout (SSTO) are available for review. This potentially reduces unnecessary calls to the surgeon’s office, allowing the clinic nurse not to be tied up on the phone.Conclusion

A ubiquitous tenet of nursing care is inclusion of patients in their care. The case of LS illustrates how even when the standard protocols are followed, misperceptions and misunderstandings can lead to accusations of malpractice. This incident also serves as an example that accepted edits to errors in documentation, such as marking through the “R” and initialing the error, are not always the best choice in all circumstances. It begs the question, if the consent form had been reprinted instead of edited, would there have been an allegation of malpractice?  Ms. Brent’s analysis of the lawsuit and conclusion that it was the nursing documentation that resulted in the dismissal of the lawsuit serves as an excellent reminder to nurses of the importance of complete documentation. Accurate records will always be crucial to supporting the providers’ actions in a lawsuit. SafeStart provides enhanced documentation shared by the entire team as well as improving communication between the patient and staff. By reducing both the perception of errors or occurrence of errors we can preserve the trust between the provider and patient thereby decreasing the potential for malpractice claims. SafeStart is a tool that nurses can use to incorporate patient-centered care into their practice, enhancing patients’ satisfaction with their care.


Brent, N. J. (n.d.). Nursing documentation saves nurse in wrong-site surgery claim.

Starnes v. Schoolcraft Memorial Hospital, No 2015-004947-NH, (Michigan Court of Appeals 2019).

SafeStart works with or without an EMR