Sign on dotted arm: How to suture right site

Joint Commission uses public pressure as prescription to cut down on wrong-site surgeries.

By Andis Robeznieks, AMNews staff. Jan. 7, 2002.

In the three years since the Joint Commission on Accreditation of Healthcare Organizations issued an alert warning physicians about "wrong-site surgeries" the problem has gotten worse, prompting the issuance of another alert.

The Joint Commission reports 150 instances of physicians working on the wrong side of a patient's body, performing the wrong procedure or operating on the wrong patient since 1995, with the number increasing every year since 1997. Fifty wrong-site surgeries were reported in 2000 and at least 58 in 2001.

Although the numbers are small compared with the number of surgeries performed each year, officials are frustrated by the fact that wrong-site surgeries occur at all.

"Health care experts are unanimous in their belief that these types of errors should never happen," said Joint Commission President Dennis S. O'Leary, MD. "Unlike many other health care dilemmas, we know how to solve this problem."

Solutions suggested in the Joint Commission alert include:

• Marking the surgical site. This can include a physician signing their name or initials or writing "wrong" or "no" on the other side.
• Creating and using a checklist that may include medical records, x-rays or imaging studies.
• Orally verifying the surgery, with members of the surgical team confirming they have the correct patient and confirming the procedure.
• Taking a "time out" to double-check the procedure and patient's identity before starting the operation.
• Establishing a monitoring system to ensure procedure compliance.