Wrong Site Surgery persists despite Preventive Measures

It is hard to believe that operations on the wrong body part or on the wrong patient still happen. But after the Joint Commission on Accreditation of Healthcare Organizations ( "JCAHO"), surgeons have operated on the wrong leg, eye, kidney or other body part 150 times since 1996. Most of the time these cases are quietly settled, but sometimes they are headlines.

Some well known examples are illustrative of this point. A patient admitted to Tampa, Florida, in hospital1995 for an amputation of a gangrenous foot had removed the wrong foot. In New York had outpatient surgery on the wrong side of his brain at Sloan-Kettering Cancer Center. A surgeon, nationally recognized for his work with breast cancer patients, two patients confused and led a mastectomy on the wrong patient in November 1998.

JCAHO alert to the continued high incidence of surgical errors, was a sentinel warning advising patients to be involved in ensuring that theSurgical site is marked even before undergoing surgery. This warning was issued in December 2001, it is the second sentinel alarm on the same type of medical error. The first call at the wrong site surgery focus has been spent in 1998 and included a review of 15 cases had been reported JCAHO. The150 of cases reported in the current database operations accounted for on the wrong body part for 76% of cases, during operations on the wrong patient accounted for 13% of cases. The falsesurgical procedure was involved in 11% of cases.

What is more alarming is that JCAHO figure actually underestimated the true incidence of wrong site surgery. Health care providers are not required to JCAHO sentinel events report. They report on these events on a voluntary basis. In fact, of the 150 cases were themselves only 81% reported by the suppliers. The Physician's Insurance Association of America found 331 applications Surgery on wrong body in the ten years between 1985 and 1995, when itreviewed malpractice claims from 22 airlines representing 110,000 doctors. And even that figure far too low, because not every case results in a claim.

Wrong site surgery can have serious consequences for patients and medical staff. In response to the first tender in 1998, the American Academy of Orthopedic Surgeons has "Sign Your Site" program of preoperative surgical site identification. Surgeons were the original planned area of operations supported by aPermanent markers. According to Dr. Terry Canale, a former president of the American Academy of Orthopedic Surgeons, found the academy that was after a period of two years of this campaign, only 60% of the surgeon's marking of its operational locations.

JCAHO is now promoting patient an active role in ensuring that surgeons operated on the right side. According to JCAHO, patients should lead to discuss two things: (1) to be in particular during the operation with both the surgeon and done,Have anesthesiologists, and (2) the surgical field, who with a waterproof pen in the presence of their surgeon, the surgeon, the first page.

The tender offers concrete steps for providers to reduce the risk of the wrong side of the operation. The JCAHO recommends that providers:

* Require that the surgery is to be marked.

* Developing verification checklists.

* Require each member of the surgical team verbally the identity of the patient, the planned reviewsurgery and the site, with the patient after the patient arrives in the operating room.

* A "time out call" for the surgical team before the actual operation begins, the patient, procedure and site check.

In 1975, the Louisiana legislature limited damage awards in medical malpractice actions to $ 500,000, exclusive of future medical expenses and legal interest. Despite the numerous challenges to this limit on constitutional grounds is the medical malpractice cap inEffect. But providers should take heed. Wrong site surgery is clearly avoidable and can result in devastating consequences for patients. Therefore, it is imperative that healthcare providers quickly adopt effective preventive measures to eliminate the wrong body surgery, face, or the real possibility of losing the medical malpractice cap. More wrong site surgery errors can put opponents of the cap with enough ammunition is available to fix it eventually, so that providers vulnerable to unlimitedDamage awards. What the legislature giveth, the legislature can taketh away.

By focusing national attention on this issue, JCAHO hopes to eliminate these avoidable mistakes. We can hope that third sentinel alert on this issue will not be necessary.

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