Monday, December 24, 2007

Wrong-site surgeries seen as pink, preventable: degree of mar was largely low

Wrong-site surgeries seen as pink, preventable: degree of mar was largely low

Key Points


* Number of wrong-site surgeries conducted on limbs or organs excluding the spine occurred once contained by every 112,994 operations.


* Degree of damage was low within the instances found in the study.


* Hospitals seem to be confused going on for processes JCAHO is recommending.


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


Researchers lead by Mary R. Kwaan, MD, MPH, of Brigham and Women's Hospital and Harvard School of Public Health in Boston, estimate that a wrong-site surgery serious plenty to result in a report to insurance risk manager or in a lawsuit would come about approximately once every five to 10 years at a single large hospital.


The study assessed adjectives wrong-site surgeries reported to a large medical malpractice insurer between 1985 and 2004 and found that the number of wrong-site surgeries conducted on limb or organs other than the spine occur once in every 112,994 operation. In addition, 40 cases of wrong-site surgery be identified among 1,153 malpractice claims and 259 instances of insurance loss related to surgical care. Of that total, 25 of the cases be non-spine wrong-site surgeries, with the remainder involving surgery of the spine.


Another interesting finding involved the broad-spectrum protocols from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), which went into effect in July 2004. According to the researchers, available medical history for 13 of the 25 non-spine wrong-site surgery cases show that injury was makeshift and minor in 10 of the cases, but that JCAHO's "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery" might have prevented eight of the cases.


An 'atypical' event


"Our interest was contained by wrong-site surgery, how it happens, and what kind of cases are at risk for wrong-site surgery events," says Kwaan, a surgical research fellow at the Brigham & Women's Center for Surgery & Public Health. "We also have some interest in finding out how hospitals reacted to the site certification protocol."


The main point Kwaan would close to to emphasize is that base on her findings, wrong-site surgery "is not a common adverse event." Previously, she say, there have not been much background on the problem. "A lot of the discussion on this problem is based on satchel reports, so we do not have denominators," she explains. "Also, we looked-for to compare [the rate of wrong-site surgeries] with lots of other illustrious errors, like a retained foreign body. We in a minute have a number: one contained by 10,000. That is far more uncommon than disappearing a sponge in the belly."


The other key issue, say Kwaan, is degree of wound, which was low surrounded by the instances found in her study. "Retained foreign bodies mostly result in pretty serious harm," she observe. "In our cases, most involved a scar requiring a second operation, but not a most important disability--and none of the cases resulted in demise," she adds.


Structured protocols


"The final point it's influential to cite is that when we reviewed the medical records, the events appeared not to hold been preventable by the [JCAHO] site preparation protocol," add Kwaan. "This is a very central finding: Despite this protocol being honestly extensive, unfortunately it is not expected to prevent every single crust of wrong-site surgery. We found it prevented 62% with diligent enforcement."


Kwaan describes the protocols as "duly structured," with three primary components. "One is pre-op verification, next to recommendations to check things close to the consent document or having the histories and physical documents within the medical record," she explains. "The second is mark the site, which has gotten seriously of attention, and the third is a time-out."


While these are "fairly specific" components of what JCAHO would approaching a hospital to do, she says they don't specify exactly how you certainly bring these about.


"It seem [from discussions with hospitals] resembling there be some confusion about what procedures should be done," Kwaan transcription. "Even though the requirements are not rocket science, they could be quite cumbersome but for planned correctly."


Given the fact that the protocols are not foolproof, what does Kwaan recommend? "For presently, one of the things we think is substantial is to have a site endorsement protocol in your hospital explicitly simple; this will promote compliance," she says. "Avoid cumbersome protocols and redundant checks, where on earth everybody knows they are checking matching thing three other nation checked. Although there is no background on this, we don't feel it will increase compliance--in certainty, we feel it will variety it easier to violate the protocols."


The pre-op verification process, she continues, should involve two condition care professionals--and one should be the surgeon. The other should be the nurse or anesthesiologist, who will verify the documents. "The most relevant is the informed consent," say Kwaan. "We also advocate that hospital policy enjoy a very clear protocol for inconsistencies, so if something comes along to be precise not matching the OR rota, a lot of stress should be placed on how that will be resolved."


Finally, says Kwaan, within the cases that were studied, "A lot of initial errors occur in the clinic weeks in the past surgery--the patient wasn't planned correctly, radiology did not label something correctly, or the documentation be not correct. We want to alert the surgeon that this is their responsibility," she says. "One agency [to avoid such errors] is to have steps taken surrounded by the clinics to ensure the correct site is identified and agreed upon with the patient--to fashion sure they have specified the correct side and site. Then, it's momentous to verify that in the consent document."


Quality manager should be aware, says Kwaan, that long-suffering safety protocols are an up-and-coming topic. "You will hear more and more give or take a few them for other types of procedures; you will read about it surrounded by the literature as we learn more and give attention to of ways to prevent errors," she says. "You will see like mad of protocol-driven prevention measures--these will hopefully be based on evidence. If you read the JCAHO protocol and you haven't thought that much give or take a few it about, it doesn't nouns like a difficult entity to do, but we found so much variety within the ways hospitals interpreted them. Even how you mark the site can be a vastly complicated administrative decision. It requires profusely of thought and research."

No comments: