239839 Wrong Site Surgery: Reasons and Implications

Tuesday, November 1, 2011

Nader Moinfar, MD , Bloomberg School of Public Health, Johns Hopkins University, Longwood, FL
Rafik Zarifa, MS MD 13' , College of Medicine, University of Central Florida, Orlando, FL
Wrong-site surgeries do not appear to have decreased since their description by the Joint Commission in 1998. Despite evidence-based data supporting the role of the Universal Protocol in reducing the risk of wrong-site surgeries, compliance amongst surgeons varies, with varying levels of compliance between specialties. Root cause analyses by the Joint Commission of a growing database of wrong-site surgeries more specifically identifies breakdowns in communication between surgical team members and the patient and family as the most common cause of wrong site surgery, followed by policy lapses such as not requiring the marking of surgical sites, failure to require operative site verification in the operating room and the performance of a verification checklist, incomplete patient pre-operative assessment, staffing issues, distraction factors, availability of pertinent information on the operating room, and organizational cultural issues. Effective reductions in wrong-site surgery appear to therefore call for a reassessment and possible modification of current interventional strategies; evolving conceptual frameworks in reducing wrong-site should account for the impact of current healthcare reform proposals on the culture of patient safety.

Learning Areas:
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
(1)Describe historical efforts at reducing the incidence of wrong-site surgery in the United States (2)List the prevalence of wrong-site surgeries with respect to surgical specialites, and identify associated causative factors with regards to subspecialty (3)Analyze the trend and trajectory of reported wrong-site surgeries in the United States, and their anticipated public health burden (4)Formulate upon current conceptual frameworks further interventional strategies to reduce the incidence of wrong-site surgery

Keywords: Injury Prevention, Quality Assurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a practicing physician and graduate student completing graduate training in public health
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.