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A SafeStart to One Man's Surgery - A Surgeon's Perspective

Patient safety and the flow of scheduled cases require accurate and thorough preoperative patient preparation of the patient’s record. Such preparation spares the surgeon’s staff and that of the facility unnecessary stress. In addition, adverse consequences may result when there is a mismatch between the planned procedure and the patient’s perception of the procedure to be done.

In this case, the patient's accusation of wrong-site surgery supported by his perception that staff had tampered with the documents spiraled into legal action. Perhaps the use of a fresh unaltered consent and the use of a better than the customarily used preop patient care process could have averted legal action. From the perspective of a surgeon [Dr. Pearl], having a tool that allows for simple access to accurate and continuously accessible information for the surgical team and the patient could have reduced such misperception.

Can SafeStart, an innovative, intuitive, user-friendly application benefit all stakeholders?

SafeStart provides image enhanced clinical documentation compliant with HIPAA in a cloud environment that makes the patient documentation continuously available to all stakeholders and reviewable by the patient.

Using the SafeStart iOS app the surgeon’s clinical office staff would have entered basic demographic information including a facial photograph. The staff would have taken a photo of the patient of the intended surgical site for the surgeon to annotate. The staff would include photos of the completed consent form, history, and physical and a key x-ray image(s). The patient (parent, or guardian in the case of pediatric patients, and caregivers) could have accessed all of this information from home to review and approve or reject for reason, any of the information using SafeStart’s web-based patient portal. For both the preoperative call and in the pre-operative area, all stakeholders would have been able to access this information and make any necessary changes. Furthermore, SafeStart notifies all stakeholders anytime changes were made to the documents.

In the operating room, the surgical team would have accessed the patient information to use the digital, patient-specific, surgical safety time out checklist used for patient identity, allergies, site of surgery, MRI images, and more. Signoff by the various users would have been time-stamped.

Perhaps if LS had the opportunity to review all of the documentation including the image annotated by the surgeon of the intended surgery site between his office visit and the time that he presented to the surgery center he and his attorney might not have pursued legal action. If questions arose prior to surgery, the entire clinical team, as well as the patient, could have accessed the patient's SafeStart profile and confirmed the surgical plan.


The surgeon and the nurse had to face a court litigation losing time and money to prepare for their defense. Intangible losses such as reputational and disruption of scheduled patients' appointments to contend with the lawsuit would not have occurred. Finally, mental stress and anxiety with being sued would have been avoided. SafeStart is an innovative and intuitive patient documentation tool, that provides the benefit of making patient documents accessible to all stakeholders throughout the patient’s journey and provides the additional benefit of increasing patient engagement in the surgical safety process.


Commentary by Richard H. Pearl, MD, FACS, FAAP, FRCS

Patients expect surgeons to be reliable caretakers with complete concern for their outcomes and safety. Every condition should be carefully diagnosed, every check-up should be fully focused on them, and every procedure should be done with meticulous care. While all of these safety measures should be taken for every single person every time, oftentimes, there is a misperception that they are not. Reports of wrong-site surgery, surgical errors, medication mistakes, and other medical mishaps are in the print and electronic media frequently enough to cause widespread distrust of the medical establishment. SafeStart, an electronic tablet-based method of patient documentation, was created by a surgeon to help deal with these problems.

SafeStart is used in the initial clinic visit, before and through preop, and into the operating room. SafeStart® requires multiple validations of systemic safety procedures to protect surgical accuracy and safety from the initial consultation to the surgeon's first incision. The technology enables both clinicians and patients to have a visual representation of the intended surgical site, facial photo identification, allergies, pertinent diagnostic images, the informed consent and other information crucial to high quality, safe patient care electronically documented and archived. The aforementioned patient information is discussed in the preoperative clinic visit and reviewed by the patient and family. The information is placed on the electronic tablet (iPad) and the patient reviews the data, surgical site with a marked and annotated picture to ensure accuracy. The consent forms are reviewed, signed, and entered as well. All of this data can be reviewed again at home by the patient and family via the secure patient portal. On the day of surgery, the preoperative nurse and anesthesia provider review the same SafeStart data with the patient to ensure accuracy and verify consent.

In the OR, the SafeStart process is used for the preoperative safety checklist prior to surgery, verifying the correct surgical site, consent, allergies, and proposed surgery. A picture comparing the clinic picture documenting accuracy is taken and entered in the record. After the surgery, the SafeStart checklist can be shared with the family.

So, now with one set of simple electronic documentation done in the clinic the entire surgical team and the patient have access to accurate and transportable information. We have conducted an initial study in 100 Pediatric Surgery patients using SafeStart throughout their surgical process. The families, nursing staff, and surgeons gave the process their overwhelmingly positive endorsement.

Elger, B. M., Esparaz, J. R., Nierstedt, R. T., Jennetten, R. C., Aprahamian, C. J., & Pearl, R. H. (2019). Engaging the patient and family in the surgical safety process utilizing SafeStart. Journal of Pediatric Surgery.

SafeStart works with or without an EMR