Steps in planning

Team preoperative planning is similar to the preflight planning required by the civil aviation community. Every commercial flight starts with a formal flight plan by the pilot in command that is somehow similar to the templating and surgical tactic conducted by the operating surgeon. The flight plan is filed with the appropriate national aviation authority, just as the surgeon must communicate his or her plan and needs to other team members including the anesthesiologist, circulating nurse, surgical scrub technician/nurse, and radiology technician. The pilot also performs an equipment check of the airplane, the instruments, and important systems just as the surgeon and surgical technician/nurse must check to make sure the proper instrument sets and implants are present and fully stocked. Finally, just before take-off the pilot does a final run-up check to ensure all essential systems are functioning properly; just as the surgeon is required at this stage to verbally perform a preoperative “time out” to confirm that the correct procedure is being performed on the right patient; that the correct site and side have been identified and marked on the patient and that appropriate permission is documented in the medical record.

A team approach means that everyone is involved, allowing and encouraging input or questions from any member. This method keeps communication open within the OR, encourages interest and involvement in the case, and establishes that while the surgeon is in charge, every member is critical to a successful operation. Mistakes tend to occur when the team members are not able to voice their concerns.

A surgical preoperative plan should include four steps: