August 1998 Bulletin

Tells two ways to avoid wrong site surgery

Observing patient being prepped, marking site can avoid mistakes

Marking your site is one of the most effective ways to reduce the risk of wrong-site surgery, but Jerrald R. Goldman, MD, one of the founders of The Doctors' Company, said a surgeon's presence when the patient is prepped for surgery is the best way to avoid the devastating and costly mistake.

"I want to say hello to my patients, examine them and then have them prepped and draped when I'm in the room," said Dr. Goldman, an orthopaedic surgeon who is chairman of the claims committee of The Doctors' Company, the nations largest physician-owned insurer, based in Napa, Calif.

"Mistakes occur when the patient has to be turned over," Dr. Goldman explained. "The mistakes can be prevented if you are there. You can't come into the operating room and just find your patient lying there, you need to be there and be proactive."

According to the Physician Insurers Association of America, there were 213 paid claims for wrong-site surgery claims between 1985 and 1997. The average indemnity payment was $54,800.

Dr. Goldman said the leg is, by far, the most common site for a wrong-site surgery to occur. "Our claims people think overwhelmingly, (the most common cause is) having the wrong leg draped when the doctor is not in the room and doctor doesn't verify the site before beginning (the surgery)," said Dr. Goldman. He tells his patients to expect the admitting secretary, the admitting nurse, the anesthesiologist and the scrub nurse to all confirm which limb will be operated on and he tells the patient not to be alarmed by this repeat questioning.

The Academy advocates eliminating wrong-site surgeries by marking the site, a practice Dr. Goldman uses and encourages among other orthopaedic surgeons.

Surgeons should place their initials on the operation site with a permanent marking pen and then operate through or adjacent to those initials. This prevention procedure is preferred over marking the wrong leg because that mark could be overlooked if the patient is prepped and draped before the surgeon is in the room.

Spinal surgery done at the wrong level can be prevented with an intraoperative X-ray that marks the exact vertebral level of the surgery. "You really need quality film (for this method)," said Dr. Goldman.

The surgeon is ultimately the "captain of the ship," according to Goldman, but PIAA statistics show that wrong-site surgeries are often the result of a failure to set up proper controls in the surgical process. Dr. Goldman said education can go a long way toward eradicating the problem. He suggested that hospitals and surgery centers should provide written protocol and hold in-service sessions to train staff in the ways to prevent wrong-site surgeries.

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