Today's News

Wednesday, March 10, 2004

Patient Safety: Top priority for AAOS

By Carolyn Rogers

The Academy's broad-based program to enhance patient safety and reduce medical errors is in high gear. Over the past 12 months, the Academy has implemented a wide range of policies, procedures and projects to ensure that patient safety remains a cornerstone of orthopaedic practice.

This comprehensive program continues the Academy's long-standing commitment to reducing medical errors. The first AAOS patient safety effort-the successful "Sign Your Site" initiative-had its roots in a 1997 task force chaired by past president S. Terry Canale, MD. "Sign Your Site" addressed the problem of wrong-site surgery head-on, earning the Academy a reputation as a leader in the patient safety arena.

In late 1999, the publication of the Institute of Medicine (IOM) report, To Err is Human, catalyzed public, payer and medical concerns about patient safety and medical errors. Although it was not the first study on medical errors, it was the first to be be made widely available to the public. The IOM estimates that as many as 98,000 Americans die each year due to preventable medical errors captured the nation's attention and focused media coverage on the issue.

By 2002, then President-elect James H. Herndon, MD, was disturbed not only by the growing evidence that medical errors are a danger to many patients, but also by the resistant attitudes to the problem among many medical professionals. Therefore, he resolved to make patient safety and reducing medical errors the primary focus of his 2003 AAOS presidency.

"Patient safety is the most pressing issue we face today," Dr. Herndon said. "We, as physicians, have become too accepting of the level of errors as something that can't be changed. I believe it is time for medical associations to step up to the plate and help devise systems that help reduce errors…If we don't implement these changes ourselves, we will lose control of our professional life to regulators, lawyers and payers."

Comprehensive program

During Dr. Herndon's presidential year, the Academy has put in place an aggressive, comprehensive program for developing, monitoring and evaluating a full range of activities to promote patient safety. The Patient Safety Committee-chaired by David A. Wong, MD, MSc-has been instrumental in accomplishing these activities.

Established in fall of 2002, the committee was charged with developing a business plan to promote orthopaedic patient safety and to reduce as completely as possible the potential of medical errors that could occur in orthopaedic practice. In response, the committee created an action plan for a series of 10 patient safety initiatives addressing a wide range of concerns to be implemented over two years. The projects fall under the areas of member communication, education, research, advocacy and outreach. The AAOS Board approved the plan in December 2002.

In addition to further promotion of the "Sign Your Site" program, the plan includes the following 10 projects:

One year later

The AAOS has accomplished a significant amount of patient-safety-related activity over the past 12 months, including research efforts, outreach and the development of numerous guidelines, policy and advisory statements, newsletters, Web sites and ready-to-use materials that both patients and physicians can employ to enhance patient safety.

A summary of the Academy's patient safety efforts over the past year follows.

Member communication efforts

Member Alerts

"One of the first items on the Academy's patient safety agenda was the development of a mechanism to quickly notify AAOS fellows of urgent news regarding medical devices, biologics and drugs that could affect patient safety," said Dr. Wong. "We wanted to develop a formal communication process for informing AAOS members about urgent patient safety news."

That is now being accomplished through dissemination of an e-mail/fax service called the "Patient Safety Member Alert." Notices are distributed separately from any other AAOS publication and are dedicated solely to informing members about urgent patient safety news on as "as needed" basis. The Academy's goal is to disseminate these important news messages to members within 4 to 12 hours of receiving them. To date, three such alerts have been issued.

Web site

Less urgent, more didactic, informational items are posted on the Academy's new Patient Safety Web site, patientsafety.aaos.org. The site serves as a focal point for all of the Academy's patient safety efforts, consolidating information for consumers, health care professionals and AAOS membership. For more details on the Web site and its offerings, see the related article in today's edition of Academy News.

E-Newsletter

To keep members informed about the progress of the Academy's work in the patient safety arena, the committee also developed a quarterly electronic newsletter, Patient Safety Update. The e-newsletter is distributed via e-mail to all Active Fellows, Candidate Members and Residents for whom the Academy has e-mail addresses.

"The aim of this newsletter is to provide members with ideas and information that can be used to implement and improve patient safety practices as well as to build a culture of patient safety in offices and hospitals," said Dr. Wong. The committee hopes that members will find this e-newsletter valuable and share the news and information with colleagues.

In addition, nearly two dozen patient-safety-related articles have appeared in the AAOS Bulletin. Links to all of these articles are on the Patient Safety Web site.

Education projects

Public education

The AAOS public education campaign, "Patient Safety Is No Accident," was launched in April 2003. The initiative included a public service announcement campaign consisting of print, radio and airport ads, as well as posters and postcards. The campaign has appeared thousands of times in magazines, weekly and daily newspapers and in more than 100 airports nationwide. The "Patient Safety Is No Accident" theme and associated logo are being used with all aspects of the Academy's patient safety program. It even has been incorporated into this Annual Meeting's logo.

Member education

In addition to the public education efforts on patient safety, a variety of member education projects are underway.

A project team is continuing work on a "Patient Safety Curriculum" targeted toward orthopaedic residency training programs. Topic areas such as the scope of patient safety concerns, the role of complex medical systems and systems solutions are being addressed. The team is tying this work to the Accreditation Council for Graduate Medical Education' six general competencies for residents.

The Board recently approved a new AAOS Advisory Statement on Prevention of Medication Errors. The statement recognizes that medication errors constitute a large percentage of medical errors, and offers a comprehensive assessment of low- and high-tech solutions that orthopaedic surgeons can utilize to decrease incidences of medication errors. Due to the systemic nature of medication errors, system problems must be addressed with the participation of pharmacists, drug manufacturers, information systems and hospital personnel. The statement is available online at the Patient Safety Web site and also at the Patient Safety Exhibit located in the Resource Center.

The Orthopaedic Medical Legal Advisor (OMLA), a quarterly newsletter dedicated to assisting orthopaedic surgeons in reducing the risk of incurring professional liability losses, recently published its fourth issue. OMLA is supported by an unrestricted educational grant from Smith & Nephew, and is distributed to all active fellows, candidate members and residents.

The OMLA Web site, which went live in March 2003, contains current and back-issues as well as an interactive section that allows readers to express their opinions on selected cases presented in the print version of the newsletter. The Patient Safety Web site contains a link to the members-only OMLA site.

"Positive Practices" initiative

The Patient Safety Committee is working with the Evidence-Based Practice Committee on a "Positive Practices" program that identifies practical steps surgeons can incorporate into their practices to enhance patient safety. These include a drug-herb interactions chart compiled by the AAOS Complementary and Alternative Medicine Committee, as well as a set of nine preprinted postoperative order forms and a patient/consumer brochure on medication erors prepared by the Patient Safety Committee. These items are available for download from the Patient Safety Web site.

A new patient safety CME module is another "Positive Practices" initiative. The module begins with a 10-minute presentation that will be shown at the beginning of all OLC courses. It ends with a faculty-led discussion of safety tips relating to the course subject and a request for feedback from the course participants via an AAOS e-mail address.

Research activities

Patient Safety in the ASC

The Patient Safety Committee's Project Team on Ambulatory Surgery Center (ASC)/Practitioner Office Errors recently generated a detailed report on patient safety in the ASC, which is now available on the Patient Safety Web site.

"Until now, most patient safety reviews had been in the hospital setting," Dr. Wong said. "Issues such as prescription interaction, identification of herbals and other health supplements with anesthetic and surgical implications as well as surgical site identification, all have application to the outpatient setting."

To further assist physicians' patient safety efforts in this area, the project team prepared concise, pre- and postoperative patient safety checklists specifically designed for use in the ASC. The preoperative checklist ensures that the surgeon has considered issues related to the particular patient's safety for the specific procedure and that certain safety-related processes have been performed prior to entering the operating room. The postoperative checklist ensures that the surgeon considers issues related to the patient's safety at discharge. The checklists are best clipped directly to the patient chart and completed and signed by the orthopaedic surgeon.

The report and checklists are free to download from the Patient Safety Web site. The documents also can be picked up at the Patient Safety exhibit, located in the Resource Center in the MCC South Lobby.

National Summit on Patient Safety Research

The Academy participated in the 2nd National Summit on Patient Safety Research in Arlington, Va., in early November 2003. The Agency for Healthcare Research and Quality (AHRQ) sponsored the summit, which addressed various aspects of patient safety, including epidemiology of patient safety risks; effective practices and tools; infrastructure for effective practices; broader adoption of effective practices; and monitoring progress and maintaining vigilance.

"I was impressed with the breadth and depth of patient research going on now, and it appears to be growing," said Robert Brooks, MD, a member of the Patient Safety Committee who attended the summit. "Partnering with such research might be an effective way for the Academy to encourage patient safety research, in lieu of setting up our own research programs. AAOS could potentially assist funded researchers by identifying member physicians who are willing to participate in patient research."

Outreach efforts

Orthopaedic Patient Safety Coalition

One of the key initiatives of the AAOS Patient Safety program is to help coordinate and extend patient safety efforts among professional medical societies involved in care of the musculoskeletal patient.

To that end, the AAOS formed the first Orthopaedic Patient Safety Coalition, consisting of more than 70 organizations involved in orthopaedic or allied health care. Together, the groups are working to reduce and eliminate medical errors through patient safety education, research, best practice initiatives and community awareness.

In addition, the Academy is partnering with such organizations as AHRQ, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and the National Quality Forum-a nonprofit membership organization created to develop a national strategy for quality measurement and reporting.

New wrong-site surgery Universal Protocol, guidelines

The AAOS participated in the recent development of JCAHO's new Universal Protocol for eliminating wrong-site surgery. This Protocol requires proper patient identification, signing of the surgical site and a preoperative huddle or "time out" for everyone involved in the surgical case, including the patient, to review the operation and ensure the proper surgical site.

The new Protocol can be found in this section. The Protocol and guidelines for its implementation are available at the Patient Safety exhibit, located in the Resource Center, and also can be downloaded from the Patient Safety Web site. (For more information on wrong-site surgery, see the accompanying article.)

The Leapfrog Group

The Leapfrog Group-a consumer-focused consortium of more than 140 public and private organizations that provide health care benefits-works to initiate breakthrough improvements in the safety of healthcare for Americans. In September 2003, Dr. Herndon was appointed to the Leapfrog Group's new Physician Advisory Group, a team of medical experts selected to help the consortium identify problems and propose solutions to improve patient safety in hospitals.

As a member of the Advisory Group, Dr. Herndon has had the opportunity to share information about AAOS patient safety programs and resources with the group. He has invited the Leapfrog Group to become a partner in the Academy's efforts and encouraged its members to make use of the Academy's many patient safety resources and materials.

"We hope this [outreach] will lead to additional efforts by other heath care organizations to reduce the incidence of error and increase the margin of patient safety," Dr. Herndon said.

Advocacy-Regulatory efforts

Critical incident research

In recent years, several pieces of legislation have been proposed that would create national or state-based medical error reporting systems. The AAOS believes it is important to include appropriate privacy protections in these systems, Dr. Wong said.

"The non-punitive 'near-miss' reporting system in the aviation industry is a good model for medicine," he said. "Data collected serves as the basis for educational and remedial efforts when issues are identified."

The AAOS recently conducted a pilot project to determine if this type of voluntary, non-punitive reporting system can produce worthwhile data about medical errors and "near misses." With the use of discussion guides created by AAOS staff, a market research firm conducted a total of 20 confidential interviews-10 with orthopaedists and 10 with orthopaedic nurses-in September 2003. The Patient Safety Committee is currently assessing the results of this study.

For details on the project, please see the related article in this section.

Patient Safety at 2004 Annual Meeting

The Patient Safety booth is AAOS members' central resource for patient safety information at the Annual Meeting.

Located at the Resource Center in the MCC South Lobby, "The booth will feature the 'Sign Your Site' model patient that appeared at last year's meeting, current advisory and position statements, and audiovisual materials," Dr. Wong said.

Technical exhibitors are also making patient safety a priority, he added. "Exhibitors have been asked to highlight the patient safety aspects of the technology demonstrated in their exhibits. For example, an exhibitor might provide tips to increase the precision and efficiency of the technology used, or have an associated techniques manual available for physicians and scrub nurses."

Look for the "Patient Safety Is No Accident" sign that indicates a participating exhibitor.

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Last modified 01/March/2004