Surgeons, Patients Can Work Together to Prevent Wrong-Site Surgery

Surgeons can team with patients to help prevent a surgical procedure from being performed on the wrong part of the body. These are the results of a study, "Patient Compliance in Avoiding Wrong-Site Surgery," published in a recent issue of The Journal of Bone and Joint Surgery (JBJS).

Although the primary responsibility to prevent medical errors rests with hospitals, healthcare providers and healthcare delivery systems, it is good practice for patients to assume a more active role in their own health care to ensure the best possible outcomes.

Christopher W. DiGiovanni, MD, who directs the Division of Foot and Ankle in the Department of Orthopaedics at Brown University School of Medicine, along with residents Lana Kang, MD, and Jennifer Manuel, MD, prospectively studied patient compliance in 100 individuals scheduled for elective foot and ankle surgery. Each received the simple, explicit instruction to clearly mark the foot that was not to be operated on with the word "NO" using a black indelible marker. The investigators categorized those patients who marked the correct foot according to the instructions as being fully compliant, those who used a mark different from that requested in the instructions as partially compliant, and those who did nothing as noncompliant.

The results of the study showed that slightly more than one half (60 percent) of the patients marked the foot correctly. The authors theorize that these surprising results suggest that many patients may believe the "system" would provide safe medical care to protect them, trust their physician enough not to worry, believe the odds of wrong site surgery happening to them are very low, or may be more comfortable with a passive role in their medical care. "The vast majority of the American public expects the system to work and trust it will get them safely from point A to point B," says DiGiovanni. Wrong-site surgery is a devastating occurrence and happens very rarely, but, as DiGiovanni states, "even once is too often, and it is 100 percent preventable." While he points out that he has personally never experienced a wrong site surgery, DiGiovanni feels his study demonstrates that physicians need to play a more active role in encouraging patient participation. "To be effective, the doctor-patient relationship must be a two way street. Patients must be encouraged to get more involved with their care in order to maximize the outcomes we all desire."

Less than 100 percent compliance with pre-surgical instructions, as shown in this study, indicates that many patients completely rely on our health care system to ensure that errors do not occur. While it is true that physicians and other health care professionals will always be the most appropriate avenue to ensure quality care, in recent years the doctor-patient relationship has changed from being primarily paternalistic to one advocating patient involvement through partnership in health care. Orthopaedic surgeons continue to find better ways of educating patients undergoing surgery and to emphasize their vital participation in their own treatment and recovery to ensure the best possible results. Preventing wrong site surgery is easiest when both physician and patient form a partnership to identify the correct surgical site.

The American Academy of Orthopaedic Surgeons has implemented a "Sign Your Site" campaign directed to its members, in which the physician marks the surgical site with an indelible marker, while the patient watches and confirms. This may seem overly cautious, but "Signing Your Site" is a step worth taking to ensure patient safety.

In addition to its Patient Safety Committee, the Academy has also developed a Patient Safety Coalition comprised of orthopaedic health-related organizations to study the problem and contribute to the discussion.

Source: American Academy of Orthopaedic Surgeons (AAOS)