Wrong-site surgeries seen as rare, preventable: degree of harm was generally low

lock opener Points

* Number of wrong-site surgeries managemented on limbs or organs other than the spine occurr one time in every 112,994 operations.

* stage of harm was low in the instances place in the study.

* Hospitals strike one as being to be confused about processe JCAHO is recommending.

Wrong-site surgery is extremely rare and major injury from it flat rarer, according to a close attention supported by the Agency for Healthcare Research and Quality and published in the April 2006 issue of Archives of Surgery (1)

Researchers l by dint of Mary R. Kwaan, MD, MPH of Brigham and Women's Hospital and Harvard academy of Public Health in Boston, estimate that a wrong-site surgery serious enough to rise in a report to insurance risk managers or in a lawsuit would arise approximately once every five to 10 years at a single large hospital.

The investigation assessed all wrong-site surgeries reported to a large medical malpractice insurer between 1985 and 2004 and ground that the number of wrong-site surgeries administrationed on limbs or organs other than the spine occurr one time in every 112,994 operations. In addition, 40 cases of wrong-site surgery were identified among 1153 malpractice claims and 259 instances of insurance los related to surgical care. Of that total, 25 of the cases were non-spine wrong-site surgeries, with the remainder involving surgery of the spine.

Another interesting finding involved the universal protocols from the Joint Commission upon the Accreditation of Healthcare Organizations (JCAHO), which went into issue in July 2004. According to the researchers, available medical records for 13 of the 25 non-spine wrong-site surgery cases present to view that injury was temporary and minor in 10 of the cases, on the other hand that JCAHO's "Universal Protocol for Preventing wrongful Site, Wrong Procedure, Wrong individual Surgery" might have prevented eight of the cases.

An 'uncommon' event

"Our interest was in wrong-site surgery in what way it happens, and what kinds of cases are at risk for wrong-site surgery events" says Kwaan, a surgical research companion at the Brigham & Women's Center for Surgery & Public Health. "We also had more [i]or[/i] less interest in finding out by what mode hospitals reacted to the site verification protocol."

The main point Kwaan would like to emphasize is that based upon her findings, wrong-site surgery "is not a for the use of all adverse event." Previously, she says, there had not been abundant data on the problem. "A fate of the discussion on this question at issue is based on case reports, thus we do not have denominators," she explains. "Also, we wanted to compare [the rate of wrong-site surgeries] with fates of other well-known errors, like a retained foreign material part We now have a number: individual in 10,000. That is far more strange than leaving a sponge in the abdomen."

The other lock opener issue, says Kwaan, is stage of harm, which was depressed in the instances found in her inquiry "Retained foreign bodies mostly be the effect in pretty serious harm," she marks "In our cases, most involved a scar requiring a next to the first operation, but not a major disability--and none of the cases ariseed in death," she adds.

Structur protocols

"The final point it's important to cite is that when we reviewed the medical records, the incidents appeared not to have been preventable through the [JCAHO] site preparation protocol," adds Kwaan. "This is a true important finding: Despite this protocol being fairly extensive, unfortunately it is not awaited to prevent every single case of wrong-site surgery We rest it prevented 62% with diligent enforcement."

Kwaan describes the protocols as "fairly structured" with three main constituents "One is pre-op verification, with recommendations to check things like the assent document or having the histories and physical documents in the medical record," she explains. "The next to the first is marking the site, which has gotten a destiny of attention, and the third is a time-out."

While these are "fairly specific" constituents of what JCAHO would like a hospital to do, she says they don't specify exactly by what mode you actually bring these about.

"It appears [from discussions with hospitals] like there was a certain quantity of confusion about what procedures should be done," Kwaan notes. "Even notwithstanding that the requirements are not rocket science, they could be quite cumbersome if not planned correctly."

Given the fact that the protocols are not foolproof what does Kwaan recommend? "For now, single of the things we think is important is to have a site verification protocol in your hospital that is simple; this will encourage compliance," she says. "Avoid cumbersome protocols and redundant checks, where everybody knows they are checking the same thing three other family checked. Although there is no data upon this, we don't feel it will increase compliance--in fact, we perceive it will make it easier to violate the protocols."

The pre-op verification proces she continues, should involve sum of two units health care professionals--and one should be the surgeon The other should be the nurture or anesthesiologist, who will verify the documents. "The greatest in quantity relevant is the informed consent" says Kwaan. "We also advocate that hospital policy have a true clear protocol for inconsistencies, in the way that if something comes along that is not matching the OR schedule, a fate of emphasis should be placed upon how that will be resolved"