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The newspaper of The Johns Hopkins University January 29, 2007 | Vol. 36 No. 19
RX for Wrong-Site Surgery: Two-Minute Briefing

By Eric Vohr
Johns Hopkins Medicine

A study of Johns Hopkins surgeons, anesthesiologists and nurses suggests that hospital policies requiring a brief pre-operation "team meeting" to make sure surgery is performed on the right patient and the right part of the body could decrease errors.

In the study, which will appear in the February issue of the Journal of the American College of Surgeons, Johns Hopkins operating room personnel were "very positive" about the briefings, according to surgeon Martin Makary, director of the Johns Hopkins Center for Surgical Outcomes Research and lead author of the study.

"Although we lack systems for uniform reporting of wrong-site surgeries to understand the extent of the problem, we observed team meetings increase the awareness of OR personnel with regard to the site and procedure and their perceptions of operating room safety," Makary said. He stressed that wrong-site surgery is exceptionally rare but entirely preventable.

A study published last year in the Archives of Surgery that looked at 2.8 million operations in Massachusetts over a 20-year period suggests that the rate of "wrong-site" surgery anywhere other than the spine is one in every 112,994 operations. The study excluded the spine because researchers defined wrong-site surgeries as operations conducted on a different organ or body part than intended by the surgeon and patient, and the spine is one body part. So, even though a surgeon may have operated on the wrong area, technically he or she operated on the right part of the body.

The Joint Commission, which evaluates and accredits nearly 15,000 health care organizations and programs in the United States, requires hospitals to have a pre-surgical conversation in the OR before every surgery.

Although no national standard for the OR conversation was set by the commission, Makary and others led efforts at Johns Hopkins to enforce the mandate, developing a standardized briefing program that became policy at The Johns Hopkins Hospital in June 2006. Since then, he has collaborated with Rochester, Yale, Columbia and Cornell universities and the World Health Organization to broaden the use and reach of the Johns Hopkins program.

During the two-minute briefing, all members of the OR team state their name and role, and the lead surgeon identifies and verifies such critical components of the operation as the patient's identity, the surgical site and other patient safety concerns. The briefing is performed after anesthesia is administered and prior to incision.

For this study, a survey of 147 surgeons, 59 anesthesiologists, 187 nurses and 29 other OR staff was given twice — before the policy was implemented and after it had been in effect for three months.

After training, a 13.2 percent increase in those who believed the policy would be effective was recorded. And more than 90 percent of those surveyed agreed with the statement that "a team discussion before a surgical procedure is important for patient safety."

"The Joint Commission identified communication breakdowns as the most common root cause of wrong-site surgeries," Makary said. "Our research indicates that OR personnel see pre-surgical briefings as a useful tool to help prevent such errors."

Before the new policy was implemented, Makary noted, many surgeons would walk into the operating room and start working without a conversation of any kind and without even knowing the names of the nurses and other staff who were assisting them.

The survey is based on a similar questionnaire designed by the airline industry to assess programs designed to reduce safety errors.

Johns Hopkins faculty members Peter J. Pronovost and Bryan Sexton also contributed to the article.


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