My Experience Working at Queen Alexandra Hospital

by Victoria Toh

The WHO Checklist

It is the 2nd of April. My work experience at QA has just begun. 8.00am start and it’s already buzzing as ever in the hospital. The hand-over from the night to the day team is commencing and the tired on-call night doctors are driving home. I am directed to E14 and it’s the beginning of my journey in the orthopaedics section. (Orthopaedics meaning the broken bones, ligaments, joints...)

The whole layout of the orthopaedic surgery theatres are different from the rest I have been in. From my perspective, hanging down from the ceiling, it looks like there are these draping plastic walls. I wonder what these are for? I later learn they are there for hygiene, to help the air circulation and to continually direct the contaminated air away from the surgery table. Very clever. The first patient is entering the theatre now, a petite and awfully lovely elderly woman. She has her snug dressing gown on and some cosy, fluffy socks on. We shall refer to her as Jenny for patient confidentiality.

The WHO checklist phase 1

The WHO checklist is a 19-item checklist to reduce human factors affecting the patient's outcome. It consists of a list of questions for the theatre staff to answer from simple checks of their name and age to the type of anaesthesia and stitching that was performed. It was created by the World Health Organisation (WHO) in 2008 to increase patient safety. It is used in over 50 countries with it showing a 38% lower odds of 30-day death after emergency abdominal surgery compared to hospitals without it. It has three target areas to address; before the induction of anaesthesia, before the incision fo the skin and before the patient leaves the operating facility. In each phase, a ‘checklist coordinator’ must confirm that the surgical team has completed the listed tasks before they are allowed to proceed with the procedure.

It is phase 1 now. The scrub nurse and anaesthetist on are checking her wristband for her name, any allergies and her procedure. They ask her to describe in her words what they are going to perform on her to ensure patient wellbeing and identify the correct knee. There is a large arrow drawn on the desired knee for surgery to further increase patient safety. It would be catastrophic if they operated on the wrong leg. It seems so crazy but it has happened before in hospitals all around the world. The wrong leg, the wrong person, the wrong procedure. I remember reading Atul Gawande’s famous “The Checklist Manifesto” in which he starts off with a story about how John, a surgeon that he had met previously in medical school, administered a lethal dose of potassium to a patient. It seems so hard to think it's possible to make such drastic mistakes with such long training but without this checklist, it would be scarily a lot more common.

Jenny, as we have called her, is all prepped and ready now. She has successfully passed the checklist and is now getting the “patient-worries” just before.

She’s nervous for her surgery I can tell as grips tightly to my hand. I reassure her that the surgeons are highly qualified and that I look forward to seeing her after. She’s smiling now meanwhile the anaesthetist administers the propofol to put her to sleep. She’s falling into her slumber but not without cracking a joke about her visiting her “La-La-Land” of dreams. Her optimistic and grateful demeanour is what is so compelling about medicine. To be able to help people in their life and make a difference in their world is a huge honour and responsibility. The surgeon on today is to perform a partial knee replacement which will last around an hour or two. Every second of surgery is so fascinating and remarkable as they defy science and reverse the problems that have occurred.

Phase 2 of the WHO checklist

Jenny is fast asleep and the team is going through the steps of the procedure. Its a Unicompartmental arthroplasty of the medial side, basically a partial knee replacement of the middle side so closer to the middle of her body. The read out the checklist as the boxes are ticked and the surgery begins.

The Orthopaedics theatre room is a very loud place to be. It's like being in medieval times. There are hammers and metal bolts to help replace her knee. The surgery goes perfectly well and it's nearly time to wake her up from her dormancy

Phase 3 now

The scrub nurse runs through all the equipment used and counts everything; she has to ensure no objects that are not required are left inside her. They are all accounted for and it is time for the anaesthetist to wake our sleeping patient. She’s slightly groggy, as everyone is after surgery and hours lying down, but soon she’s smiling again. She’s delighted it's finished and she can freely walk in her local park that she is describing now. And off she goes now to recovery.