The Plimsoll Line
Most people are familiar with the Plimsoll Line. It is the line painted on the side of ships to prevent them from being overloaded. Before the Plimsoll Line came into being, ships sunk with monotonous regularity. The Plimsoll Line was made compulsory on all British ships in 1876, thereby regulating payloads to within safe margins of the freeboard in order to prevent sinking from overloading. In operating theatres, a similar problem exists. Overwhelming workload increases risk of error. At present we have no Plimsoll Line to tell us when enough is enough. We plough on through the day regardless, sailing with the sails set for maximum speed into the storm clouds ahead. We appear to have no benchmarks which indicate for us the relative safety of the ship we are sailing. Or do we? The benchmark for a safely supported clinical operating theatre seems to exist within the Standards for operating theatre practice. The Standards, rigorously researched and peer reviewed, set out the safe minimum standards for operating room practice including staffing levels and skill mix. They form the Plimsoll Line for a safely supported workplace. Should staff levels and systems of work allow for better than the minimum specified due to local variances, then the system can be considered to be well supported (WS) and their ability to meet predictably predictable contingencies robust. Should staff levels and systems of work be insufficient to meet the standards, then the system can be considered to be unsupported (US) and the potential for meeting predictably predictable contingencies weak. The risk is obvious. Once upon a time, not so long ago, overvalued, overinsured and overaged ships were lost at sea with reckless abandon, sent deliberately to their demise for the purposes of profiteering. With death from preventable medical error the third highest cause of death because clinical settings are set adrift overburdened with workload and with too few staff and planning contingencies to counterbalance fatigue and the high risk and emergent nature of our work, are we any better? Bring in the Plimsoll Line for healthcare. Lives are being needlessly lost whilst our planning algorithms are all at sea!