Fighting medical errors

Checks: Hospitals must now take simple but indispensable steps to help prevent mistakes.

Medicine & Science

July 05, 2004|By Julie Bell | Julie Bell,SUN STAFF

Dr. Roger W. Voigt wasn't confused about the operation that he was about to perform on Don and Jackie Choate's son, nor where his first slice into the 9-month-old boy would be.

But Voigt nonetheless stopped to visit little Trey just before the surgery last week at the University of Maryland Medical Center, scrawling his initials on the boy's lower right abdomen to mark the spot while Trey's parents watched.

"It was reassuring to me that he came before the operation," Jackie Choate said as she fed Trey a bottle after the surgery, in which Voigt successfully explored for a testicle that hadn't descended into the scrotum before birth.

Having surgeons - rather than another member of the medical team - mark the spot to be operated on is a new twist on an old custom. It's one of a number of steps a key hospital accrediting organization began requiring institutions to implement last week. The goal is to put an end to a rare but shockingly persistent kind of error: surgeries on the wrong patient or the wrong body part.

Many of the accidents are notorious: The diabetic Tampa man whose healthy left foot was amputated, leaving his diseased right one; the case, detailed in People magazine, of a woman harmed when a surgeon operated on the wrong side of her brain because he used the wrong X-ray; the cancer-free woman who underwent a double mastectomy after her biopsy results accidentally were swapped with another patient's.

Frustrated by previous efforts that have failed to stamp out the problem, the Joint Commission on Accreditation of Healthcare Organizations is trying again. Starting last Thursday, hospitals' accreditations - which the vast majority of U.S. hospitals use to be deemed eligible for Medicare reimbursement - are theoretically in jeopardy if they refuse to follow the commission's new rules for preventing such mistakes.

While the commission has required hospitals to have procedures for marking body parts before surgery since January last year, its new universal protocol requires every hospital to take this and other steps in the same way. The idea partly is to cut down on confusion when doctors, who often have privileges in multiple hospitals, perform surgery in more than one.

Before, "One hospital might mark the operative site, and another might mark the nonoperative site," commission spokesman Mark Forstneger said.

The commission hopes the new, more detailed guidelines will be more successful. It first issued an alert about wrong-site surgery in August 1998, after learning about 15 cases through a voluntary reporting program. In 2001, when the total reported to it had grown to 150, the commission issued another alert.

Despite the warnings, the commission continued to receive five to eight reports of wrong-site surgery every month, a number it admits likely underestimates the problem. Alarmed, the commission began requiring hospitals last January to take a "timeout" before surgery to confirm the patient on the table was the right one. It also began requiring them to mark surgical sites on patients, though they were allowed to come up with their own method of doing so.

Hospitals such as Johns Hopkins and the University of Maryland say they have been practicing the rules ever since. But the first year those rules were in effect, compliance nationally was spotty - especially when the hospitals didn't know joint commission surveyors were coming.

Unannounced visits to 172 facilities found 77 percent were compliant with the timeout requirement. Sixty-nine percent could show they were always marking patients before surgery.

Among other things, the new rules say the person performing the surgery should be the one to do the marking. The requirements for timeouts before surgery are more detailed and include verifying that the patient is in the correct position on the table and that all needed medical equipment is there.

The process was on display last week during Trey Choate's surgery, when nurse Janet Dill called a timeout.

Voigt then checked the name tab on Trey Choate's ankle bracelet to ensure he had the right baby, and he called out that the side marked for surgery was the right side. "Right" answered the anesthesiologist, Dr. Anne Savarese.

All might seem like overkill, but Voigt - who estimated he has done the kind of surgery performed on Trey more than 4,000 times - likes the rules.

"I live in fear of doing wrong-site surgery," he said.

Surgery tips

Patients should also be involved in ensuring that doctors perform the correct operation, according to the Joint Commission on Accreditation of Health Care Organizations. Here are some tips to ensure all goes well:

Make sure the surgeon marks the spot on your body that is to be operated on, and verify that it's correct.

Make sure that only the location where the surgery is to be performed is marked.

Ask your doctor if he or she plans to take a "timeout" with the surgical team before beginning your surgery.

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