Survey of terminology used for the intraoperative direction of C-arm fluoroscopy.

BACKGROUND: Orthopedic surgeons depend on the intraoperative use of fluoroscopy to facilitate procedures across all subspecialties. The versatility of the C-arm fluoroscope allows acquisition of nearly any radiographic view. This versatility, however, creates the opportunity for difficulty in communication between surgeon and radiation technologist. Poor communication leads to delays, frustration and increased exposure to ionizing radiation. There is currently no standard terminology employed by surgeons and technologists with regards to direction of the fluoroscope. METHODS: The investigation consisted of a web-based survey in 2 parts. Part 1 was administered to the membership of the Canadian Orthopedic Association, part 2 to the membership of the Canadian Association of Medical Radiation Technologists. The survey consisted of open-ended or multiple-choice questions examining experience with the C-arm fluoroscope and the terminology preferred by both orthopedic surgeons and radiation technologists. RESULTS: The survey revealed tremendous inconsistency in language used by orthopedic surgeons and radiation technologists. It also revealed that many radiation technologists were inexperienced in operating the fluoroscope. CONCLUSION: Adoption of a common language has been demonstrated to increase efficiency in performing defined tasks with the fluoroscope. We offer a potential system to facilitate communication based on current terminology used among Canadian orthopedic surgeons and radiation technologists.

Surgical site signing and "time out": issues of compliance or complacence.

BACKGROUND: Wrong-site surgery remains a common problem as voluntary preoperative skin-marking protocols have met only limited success. The purpose of the present study was to investigate orthopaedic surgeons with regard to their site-signing practices and "time out" procedural compliance for emergent and nonemergent surgical cases in a single health-care region before and after the institution of the "time out" protocol of the Joint Commission on Accreditation of Healthcare Organizations. METHODS: In the first study, performed in 2006, the presence of the initials of either the surgeon or the surgical resident in the draped surgical field was documented at the time of forty-eight procedures over a three-month period. In a second study, performed a year later, 231 randomly selected procedures were similarly evaluated, as was the performance of the newly adopted "time out" process. RESULTS: In the first study, after surgical field draping, the surgeon's initials were visible in 67% of emergent cases and 90% of elective cases. In the second study, the surgeon's initials were visible in 61% of emergent cases and 83% of elective cases. The "time out" was performed prior to the skin incision in 70% of the cases, was performed after the incision in 19%, and was not performed at all in 11%. CONCLUSIONS: Orthopaedic surgeons should recognize the value of preoperative skin signing for all procedures and the additional value of the "time out" protocol. We recommend that surgeons strive for 100% compliance with both strategies.