February 2004 Bulletin


Point of View

Board approves concept for Expert Witness Assessment and Disciplinary Program, position statements, clinical guideline on OA of the knee, and advisory statement on prevention of medication errors

The Board of Directors (BOD) of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) met Dec. 5-6, 2003, in Chicago and took the following actions:

Expert Witnesses Program approved in concept. Following approval of funding for an educational and remediation program regarding orthopaedic expert witness testimony, the Board actively sought member input regarding the interest in, and desirability of, expanding this initiative to include an expert witness testimony assessment and disciplinary program. Results of a member survey indicated strong support for such a program.

Representatives of the American Association of Neurological Surgeons presented information about that organization’s Professional Conduct Program, which has become a model for such programs within the medical field. After extensive discussion, the Board approved the concept of an AAOS Expert Witness Assessment and Disciplinary Program and directed that a project team be appointed to develop parameters for the new program.

Patient Safety in Ambulatory Surgery Center addressed. The AAOS is dedicated to improving patient safety by implementing programs to ensure that it becomes a cornerstone of orthopaedic practice. Upon recommendation of the Patient Safety Committee, the BOD approved the Patient Safety in the Ambu- latory Surgery Center (ASC) Report and ASC Preoperative and Postoperative Checklists, which will assist physicians’ efforts to improve patient safety in the ASC. All three documents have been placed on the AAOS Patient Safety Web site and can be found at http://patientsafety.aaos.org.

The concise checklists can be clipped directly to the patient’s chart, and completed and signed by the orthopaedic surgeon. The preoperative checklist ensures that the surgeon has considered issues related to each patient’s safety for a 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. These checklists are available (in PDF format) for downloaded free of charge on the AAOS Web site at http://patientsafety.aaos.org .

The BOD previously approved a revised Advisory Statement on Wrong-Site Surgery and endorsed the Joint Commission on Accreditation of Healthcare Organizations’ “Universal Protocol for Eliminating Wrong-Site, Wrong-Procedure, Wrong-Person Surgery.” For the full text of the advisory statement visit the AAOS Web site at http://www.aaos.org and click on “Library and Archives,” then on “Policies,” then on “Advisory Statements.” To view the Universal Protocol, visit the AAOS Patient Safety Web site at: http://patientsafety.aaos.org.

Position Statement on Limiting Resident Duty Hours approved. Upon recommendation of the Academic Advocacy Committee, the BOD approved a new “Position Statement on Resident Duty Hours.” The statement says that “The American Academy of Orthopaedic Surgeons (AAOS) recognizes that residents are physicians in training and require an environment in which they achieve an education of the highest quality, while providing patients with safe and responsive care. Compliance with current ACGME duty hour standards and/or applicable state law is required.” The Statement also expresses concern that the new rules potentially will add considerable costs for academic medical centers already struggling with decreasing third-party payments and reductions in government reimbursement for services. It states that without adequate and appropriate staffing and financial support, teaching institutions will not be able to address both their education mission and their obligation to provide quality patient care successfully.

For the full text of the statement, visit the AAOS Web site at http://www.aaos.org and click on “Library and Archives,” then on “Policies,” then on “Position Statements.”

Advisory Statement on the Prevention of Medication Errors approved. Upon recommendation of the Patient Safety Committee, the BOD approved an “Advisory Statement on the Prevention of Medication Errors.” Following the publication of the 1999 Institute of Medicine report, To Err is Human, medication errors surfaced as a significant source of medical errors. This statement provides an assessment of high and low technological solutions that practicing orthopaedic surgeons can use to decrease the incidence of medical error.

It states that “The AAOS recommends the following tools when prescribing, transcribing, dispensing, administering and monitoring patient medications: computerized physician order entry (CPOE), computerized decision support systems (CDSS), computerized monitoring of adverse drug events, pharmacist assisted rounds, high-risk drug protocols, and verbal order verification. These tools have significantly reduced medication errors, improved quality of care and patient management capabilities, increased reimbursement, and decreased billing time.”

For the full text of the statement, visit the AAOS Web site at http://www.aaos.org and click on “Library and Archives,” then on “Policies,” then on “Position Statements.”

AAOS Clinical Guidline on Osteoarthritis of the knee approved. Upon recommendation of the Evidence-Based Practice Committee and the Council on Research and Scientific Affairs, the BOD approved the AAOS “Clinical Guideline on Osteoarthritis of the Knee (Phase II).” The guideline is divided into two parts and was developed by the committee’s Knee Evidence Analysis Work Group, which performed a comprehensive review and assessment of literature related to osteoarthritis (OA) of the knee in developing the guideline. It was created to improve patient care by outlining appropriate information gathering and decision-making processes involved in managing OA of the knee in adults. The guideline is particularly important at this time because the growing elderly population and an increase in obesity have resulted in an increased prevalence of OA of the knee.

Phase I of the guideline addresses the treatment rendered by a family practitioner or general practitioner during the first 12 weeks after a patient presents with pain due to OA of the knee. Phase II deals with the management of OA of the knee by “musculoskeletal specialists.” To read the full text of the guideline, visit the AAOS Web site at www.aaos.org and go to “Research,” then click on “Guidelines.”

Revised Knee Bracing Position Statement approved. Upon recommendation of the Evidence-Based Practice Committee and the Council on Research and Scientific Affairs, the BOD approved a revised Knee Bracing Position Statement. The statement was first developed in October 1997 and, under AAOS policy, underwent a regular review for updating.

The Committee’s Sports Medicine Evidence Analysis Work Group performed a comprehensive review and assessment of literature related to knee bracing and revised the existing position statement, providing additional levels of evidence information for all references and adding “strength of recommendation” for all recommendations listed in the position statement. To view the position statement in its entirety, go to the AAOS Web site at www.aaos.org and under “Library and Archives,” click on “Policies” and go to “Position Statements.”

New Chair of Professional Liability Committee appointed. Upon recommendation of the Committee on Committees, the Board approved the appointment of David D. Teuscher, MD, as new chair of the Professional Liability Committee. His appointment becomes effective at the 2004 Annual Meeting.

AAOS 75th Anniversary Project Team appointed. An anniversary project team was appointed to oversee and coordinate the activities, events and materials associated with the planned commemoration in 2008 of the Academy’s 75th anniversary. Robert W. Bucholz, MD, first vice-president, and James J. Hamilton, MD, will co-chair the team. Other volunteer members appointed are Joseph Barr, MD, and Henry H. Sherk, MD. An orthopaedic resident and several past presidents will be named to the team at a later date.


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