Increase in wrong surgeries prompts alert

AP Medical WriterCHICAGO (AP) -- An alarming increase in the number of surgery mistakes involving operating on the wrong body part or wrong patient have been reported to a group that regulates hospital quality, prompting an alert urging better communication between patients, doctors and nurses.

Wednesday's alert from the Joint Commission on Accreditation of Healthcare Organizations follows a similar message from the group in 1998, when it reported on 15 "wrong-site" cases. Since then, 136 cases have been reported to the commission -- 108 in the last two years and 11 in the past month alone.

"This is really an embarrassment for any place that has this happen. This is not infrequent," said Dr. Dennis O'Leary, the commission's president.

Such errors are completely preventable with measures as simple as marking surgical sites with messages like "Operate Here" in indelible ink and having patients involved in that process, O'Leary said.

Most cases involve orthopedic or foot-related surgery -- operating on the left knee instead of the right knee, for example. A significant number are emergency operations.

During a teleconference on the alert, Dr. S. Terry Canale of the American Academy of Orthopaedic Surgeons said evidence suggests about one in four orthopedic surgeons will do a "wrong-site" surgery during his or her career.

In some cases a surgeon might mistakenly operate on a body part that looks normal, but in many cases, mistakes are made because patients have two bad knees or many bad joints, O'Leary said.

"It's very easy if you're going to do an arthroscopic surgery of the knee to get mixed up and do the wrong one," Canale said, or in hand surgery, "quite often someone will operate on the right hand but wrong finger."

Of 126 cases analyzed by JCAHO, 76 percent involved operating on the wrong body part, 13 percent involved surgery on the wrong patient and 11 percent involved the wrong surgical procedure.

"We have cases where the wrong kidney was taken out, wrong joints have been operated on -- just about anything you can imagine that might confuse left and right," O'Leary said.

"You get patients with similar names, X-rays get reversed in view boxes, people are too busy or rushed to check charts and sooner or later something happens," he said.

Many of the mistakes occurred in outpatient settings, where patients arrive, have surgery and go home on the same day, having little interaction with the surgeon. A decade ago such surgeries were rare and most patients were operated on after spending a night in the hospital, said Dr. Thomas Russell, executive director of the American College of Surgeons.

Speeding up the process "has put stress on the providers," he said.

In a joint effort with the American College of Surgeons and the American Medical Association, JCAHO is stepping up surveillance of such errors. The commission's surveyors plan to start close monitoring of hospitals early next year, and those that aren't in compliance with patient safety procedures could risk losing their accreditation, O'Leary said.

Most cases involve a breakdown in communication between surgical team members and the patient and patient's family. JCAHO said surgical teams should consider taking a "time-out" in the operating room to make sure they have the correct patient, procedure and surgery site.

"It is most important that there be cooperative openness between the surgeon and the nurses," Russell said. "The two groups must take responsibility and if there are questions, they should stop and clarify to be sure everyone is on the same page. No one should make assumptions."

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JCAHO: http://www.jcaho.org