Of particular interest to those of us at teaching hospitals was the symposium on the Economics of Health Care. Here we were able to discuss various economic issues affecting residents including the high levels of student loan debt and the looming threat of cuts to Graduate Medical Education (GME) funding.

The symposium also discussed the proposed rules from the Centers for Medicare and Medicaid Services to cut payments for so-called “never events” – incidents in providing care that CMS claim should “never” happen and, as such, should not be compensated. This particularly affects teaching hospitals, since residents, as a part of their training, will naturally have more “never events” compared to hospitals that do not use have residents. In studies analyzing different outcomes in common surgical procedures and comparing the results for more experienced and less experienced residents, the latter have more complications.

Finally, the current economic climate was also thought to be bad news waiting to happen for resident education as health care likely will be one of the casualties of budget cuts over the next fiscal year.

On the second day of the Congress, we were invited to sit in on the deliberations of the Committee on Perioperative Care as they revised their statement on operating room safety as it related to needle stick injury prevention, double gloving, the use of Engineered Safety Device, and the utilization of the Hands Free or Neutral Zone. I was able to meet Committee Chairman Dr. William Schechter, Dr. Ramon Buerger, and Linda Groah, RN, Executive Director of the Association of Perioperative Registered Nurses (AORN) which represents over 42,000 nurses!

The committee was very open to the goals of CIR’s OR Safety Task Force, and there was a great feeling of enthusiasm for our ongoing participation! During this meeting, I was able to converse with Dr. Schechter and personally extend him an invitation to come to New York to meet with members of the OR Safety Task Force and other residents. He enthusiastically agreed. I also met with Daniel Vetrosky from the American Association of Surgical PAs (AASPA). He very enthusiastically shares our vision for a safer work environment.

Overall, I felt there was a very positive spirit of co-operation. This generated a great deal of good will, which will hopefully translate to all of the team members in an operating room as we work together to promote a culture of safety.

In addition I attended an afternoon panel session devoted to operating room safety, needlestick injury, and specially engineered safety devices. It was great to see Dr. Martin McKary of Johns Hopkins University on the panel, since he wrote the article which inspired our interest in OR Safety.

Interestingly, many of the speakers on the panel drew attention to the fact that surgeons who avoid proven methods of preventing injuries were behaving as though they were invincible. This attitude is a change from the "AIDS" scare of the 1990s, and indicates that the sense of urgency that was associated with possible acquisition of the virus has been tempered over time. I’ve seen this attitude affect even the Centers for Disease Control (CDC), which over the last five years has stopped listing the occupational transmission of Hepatititis on their website.

Widespread lack of reporting among physicians also leads to physicians denying themselves appropriate Workers Compensation if a transmission were to occur, and delaying the use of medications to significantly reduce the transmission rate in HIV and to reduce the likelihood of chronicity with Hepatitis C. Another interesting point I heard during the session was that surgeons who did not double glove were more likely to have lower rates of immunizations against Hepatitis B. This suggests a certain pervasiveness of unsafe conditions.

After this wonderful and informative session, I met with medical students from all over the country who were interested in surgery and was able to offer advice from my own experiences as a surgical resident.

Overall, this was a wonderful experience, and I had a productive time in San Francisco meeting with others who share our passion for safety for all OR team members – including the residents who are on the front lines every day.