Today's News

Wednesday, March 10, 2004

Safety goal: Eliminating wrong-site surgery

By Carolyn Rogers

The AAOS and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are working together in a new nationwide effort to eliminate wrong-site, wrong-procedure and wrong-patient surgeries.

The Academy participated in the recent development of a new JCAHO Universal Protocol for eliminating wrong-site surgery, which it also endorsed. The new Protocol was created to standardize presurgery procedures for verifying the correct patient, the correct procedure and the correct surgical site. Modeled in part after the Academy's "Sign Your Site" initiative, it entails marking the surgical site, involving the patient in the marking process and taking a final "time out" in the operating room to double-check information among all members of the surgical team.

The new Universal Protocol and guidelines can be found in this section of Academy News. In addition, the documents are posted on the AAOS Patient Safety Web site and are available at the AAOS Patient Safety Exhibit, located in the Resource Center in the Moscone Convention Center South Lobby.

"Sign Your Site" campaign

In 1997-concerned by increasing reports of wrong-site surgery among orthopaedic surgeons-James Heckman, MD, then AAOS president-elect, made the development of a Task Force on Wrong-Site Surgery one of his presidential initiatives. The primary charge of the task force was to determine the prevalence of wrong-site surgery error and to develop recommendations for preventing it.

In response, the AAOS developed an awareness campaign-"Sign Your Site"-that kicked off in 1998.

"The Academy developed a logo, issued an advisory statement, produced audiovisual programs and exhibits, introduced the concept at all surgical skills courses, instructional courses and specialty day meetings, and mailed 20,000 informational flyers to orthopaedic surgeons and operating room committees," said S. Terry Canale, MD, past president and chair of the task force.

the 2000 AAOS Annual Meeting, an on-site survey revealed that 77 percent of orthopaedic surgeons were aware of the "Sign Your Site" program, and that nearly half had begun to institute or promote the program, he reports.

Since that time, more and more attention has been focused on wrong-site surgery and its prevention. In 2003, JCAHO made the elimination of wrong-site, wrong-patient, wrong-procedure surgery one of its National Patient Safety Goals.

"JCAHO recommended that there be a preoperative verification process-such as a checklist-to confirm that appropriate documents such as medical records and imaging studies are available," Dr. Canale said. "It also endorsed the AAOS concept of marking the surgical site and involving the patient in the marking process."

AAOS renews campaign

"Current data indicate that one in five orthopaedic surgeons will have an occurrence of wrong-site surgery in his or her career," Dr. Canale said.

However, because most data is self-reported and most surveys have discovered only cases that led to litigation, this probably is a significant underestimation of the true incidence of wrong-site surgery.

"The AAOS is renewing its campaign with the goal of decreasing orthopaedic medical errors with preventive rather than punitive programs, which might lead to under-reporting of surgical errors," he said.

Recently, the Academy revised its advisory statement to include the recommendation that the entire surgical team take time before anesthesia is administered to "huddle" in the operating room to make sure that:

  1. The patient and operative extremity are correctly identified.
  2. Everyone on the team understands the procedure and is aware of possible complications and how to react to them.
  3. The correct equipment, implants and devices, as well as technical assistance from the manufacturer, are readily available.

"Should be standard policy"

"The AAOS and the JCAHO recommend marking the surgical site in a way that is readily apparent to the surgeon, operating room staff and patient," Dr. Canale said. "The 'Sign Your Sight' protocol is a simple, straightforward program that requires only a minimal amount of time to eliminate the risk of wrong-site surgery, and it should be standard policy in health care institutions."

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Last modified 20/February/2004