“Stop the line” is a very familiar term to me, through my years of experience in the hospital setting. It is a term that is more commonly used in the OR suite, but not uncommon in all patient care areas of the hospital.
Having the authority—or more importantly, the responsibility—to take a stand and “stop the line” when something is not safe, policies are not being followed, or the patient is being put at risk is an important role for any hospital associate. It’s a term that drives the message home that we all have a responsibility in patient safety.
Increasingly, more and more clients are asking credentialing-related questions about neuro-monitoring technicians in the OR as well as neurologists who are remotely reading and/or interpreting the tests being monitored. I find the questions surprising—not only because this is not a new practice, but because of the question itself, “Who is credentialing the neuro-monitoring techs and do we also need to credential the physician even if he is not in the OR?”
Unfortunately, the question is often asked after the fact and could be coming to light as a result of a lawsuit. Typically, a spine case includes not only a primary surgeon but also a neuro-monitoring technician and a neurologist monitoring remotely. However, when a case goes bad, the plaintiff is looking for any loop hole that can support their case for malpractice. In more and more cases, hospitals are finding themselves in negligent credentialing lawsuits if and when they do not follow their own policies that ensure all members of the OR team are privileged appropriately and permitted to be in the OR suite.
Surgical cases are scheduled every day. Some cases are scheduled in advance and others are scheduled emergently. In either situation, the hospital has a responsibility to confirm that the surgeon and all members of the OR team are privileged appropriately and permitted to be in the OR, physically and/or remotely.
Many organizations have contracts with neuro-monitoring companies that clearly set out the expectations and verification requirements for those individuals entering the hospital and being present in the OR suite. In some cases, the contract may defer the background check to the vendor’s credentialing process; in other cases, the technicians to go through the organization’s Human Resources verification process. The contract may even include reference to physicians who are remotely involved in the case but who, under Joint Commission standards, must be privileged through the Medical Staff credentialing process.
How can an organization avoid a negligent credentialing lawsuit, specific to the OR suite and the team present in the case? At what point can someone “stop the line” if there is a risk to the organization or patient safety? Ideally, organizations would have a quick and easily assessable process in place in which the OR scheduler can verify that the physician(s) and any other non-associate included in the case have been privileged and/or cleared to be in the OR suite at the time the case is being scheduled. Most organizations have an electronic mechanism in place for the scheduler to confirm privileged physicians through a real-time database managed by the Medical Staff office. If the scheduler is not able to confirm privileges, he or she can communicate immediately that an alternate physician with privileges needs to be identified. Verification of the neuro-monitoring technicians differs between hospitals. Some organizations address the validation processes through a contract with the vendor’s credentialing services, while others have their Human Resources department manage these individuals. Regardless of the process, somewhere, somehow, credentials need to be verified before anyone is permitted in the OR suite.
The OR staff and primary surgeon have a number of responsibilities to complete prior to starting a case, such as patient identity, date, and time. Confirming the OR team present, to include remotely, is just as important as confirming patient identity and will reduce any risk to the hospital for negligent credentialing. If any practitioners have not been validated through an appropriate pathway, they should not be in the OR; if any are present, someone needs to take responsibility to “Stop the line”.