Surgical malpractice: what are the most common errors and how to avoid them?

More than 40 million Americans are undergoing surgery every year. An estimated 35.8 million of them will immediately return home after having their surgery performed in a freestanding ambulatory surgery center or in a hospital-based outpatient setting. Another 7 million will be required to stay at the hospital after their surgery. While most patients fully recover from their surgery without problems some of them will suffer from surgical complications or errors. It is estimated that around 14% of surgical patients encounter at least one adverse event.

In a recent study, the ECRI and the Institute for Safe Medication Practices took a close look at surgical malpractice and analyzed 2,400 surgical adverse events that were recently reported to them. Among these 2,400 reported surgical malpractice events, researchers found that 1,561 of them were relevant. They found that 478 of them (31%) were complications related to the surgery, 460 (29%) of them were adverse events related to patient and operating room readiness,  377 (24%) were retained surgical items, 102 (6.5%) were contaminations, 80 (5.1%) were adverse events caused by equipment failure and 64 (4.1) were wrong surgeries.

To reduce these adverse events, the ECRI recommended the following strategies:

• Reduce complications related to surgery by adopting evidence based surgery, managing and reducing risks associated with anesthesia, using regular simulation training and skill refresher for the OR staff, mitigating risk for pressure and skin injury during surgery
• Improve readiness of the patient and the OR  by implementing a preoperative assessment process, optimizing the schedule, ensuring that OR rooms are set up proprely and appropriate instrumentation is readily available, reviewing informed consent policies and procedures
• Avoid the retention of surgical items by having clear policies and procedures, educating the staff on surgical count and best practices, regularly inspecting the surgical equipment, using technologies in addition to manual count, avoiding distraction during surgical count
• Prevent contamination by making sure that reprocessing protocols are up to date and aligned with manufacturer guidelines, making sure that the OR team is cooperating with the sterile processing department, making sure a system is in place for loaned instruments, developing a comprehensive quality management program
• Prevent equipment failure by proprely inspecting and maintaining the equipment, making sure that the staff using the equipment is proprely trained, proprely reporting internally and externally any equipment failure
• Avoid wrong surgery by developing clear policies and procedures and monitoring compliance, raising awareness among the staff, changing behavior and creating a culture of safety.

Read more in the ECRI executive summary

Picture: courtesy of Wikipedia