Monday, December 31, 2012

Never?

This study from Johns Hopkins surprised the hell out of me:
After a cautious and rigorous analysis of national malpractice claims, Johns Hopkins patient safety researchers estimate that a surgeon in the United States leaves a foreign object such as a sponge or a towel inside a patient’s body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week and operates on the wrong body site 20 times a week.
The researchers, reporting online in the journal Surgery, say they estimate that 80,000 of these so-called "never events" occurred in American hospitals between 1990 and 2010 - and believe their estimates are likely on the low side
 
The numbers seem quite high, but it's hard to argue with the methodology of using historical information from the National Practitioner Data Bank.  And one can assume that even these results underestimate the true problem; not all patients sue for retained sponges or wrong site surgeries.  It truly is mind boggling to me, a practicing general surgeon, that we are leaving foreign bodies inside patients to the extent of 39 times a week.

It's unacceptable, of course.  And in this era of the Timeout, pre-operative marking of the surgical site, and Checklists, hopefully future outcomes will not be so alarming.     

I am a member of QA committees at two hospitals.  The wrong site surgery events I have come across could be attributed to a confluence of factors---nursing, surgeon, systems management.  There is never intention to do harm; carelessness and built-in systemic errors will overcome even  the most dedicated of professionals. 

Rules of thumb that I have observed:
  • Patients with dementia or severe cognitive deficiencies are red flags for potential wrong site surgery 
  • The surgeon ought to obtain his own consent from every patient, every time (don't foist the duty off on nursing or midlevels)
  • weekend/night surgery; systems can break down during off hours.  It's very important to maintain proper protocols no matter when procedures are done
  • Procedures done by covering surgeons (i.e. primary surgeon unavailable and his/her partner "fills in") are a huge red flag.  No way are these covering surgeons as well informed as the one who initially saw patient.
  • The surgeon needs to run the "timeout".  It isn't the nurse's job. 

5 comments:

Attorney Andy said...

It would be interesting to know how many of those mistakes are repeated by the same surgeons. I have seen statistics in the past that suggest that most cases of malpractice in hospitals are the result of mistakes by a select few group of incompetent physicians. Malpractice suits are an effective way to get the repeat offenders out of practice, making things safer for patients and improving the overall reputation of your profession.

Frank Drackman said...

39 times a week????

The guys busy at least.

Frank

Buckeye Surgeon said...

AA-
The study indicated that 60% of the surgeons were cited in more than one event. Transparency is always best.

Two options: regulatory bodeis who forcibly remove repeat offenders from practice vs public postings of names/transgressions and let the open market decide who to see for surgery.

Attorney Andy said...

I agree, Buckeye. In the legal profession, when you commit an ethical violation, no matter how small, your name and case are published in the state supreme court's bar journal and distributed to everyone. In the medical profession, if you commit malpractice no one knows (unless you are sued) except for you, your insurance company, and a privileged/confidential peer review committee at your hospital. Greater transparency would be good.

MultilingualMob said...

“To err is human; to forgive, divine”...But to take lunch!

http://jonathanturley.org/2012/09/06/swedish-man-dies-after-doctor-leaves-for-lunch-in-middle-of-surgery/