Still Too Many Never Events

Wrong procedures, leaving items behind in patients and OR fires — surgery's "never events" — might not happen often, but they happen often enough to cause concern, according to a study published in JAMA Surgery.

The researchers analyzed 138 studies conducted between 2004 — the year the Joint Commission's Universal Protocol was introduced — and June 2014 that involved incidence reporting of these 3 never events. Wrong-site surgery occurred 0.09 times per 10,000 procedures and retained items 1.32 events per 10,000 procedures. The incidence of surgical fires was unknown.

According to the researchers, communication problems were the most frequent cause of wrong-site surgery, accounting for 21% of 672 identified root causes. Retained surgical items were caused by a variety of risk factors, notes the study, including patients' body-mass indexes, inadequate staff communication and incomplete or undocumented counts. Surgical fires, say the researchers, were caused by a lack of awareness of fire risks and surgical teams' failures to communicate.

The study's tabulations translate into approximately 500 wrong-site surgeries and 5,000 retained items occurring each year based on an estimated 50 million surgeries performed annually.

Although few studies of interventions that prevent never events have been conclusive, the researchers say their findings suggest inadequate staff communication is the underlying cause of most surgical errors. They also wonder whether error occurrence can be reduced to zero to achieve a true never-event rate. To enhance patient safety efforts, the study's authors call for improved evaluation of how mistakes in the OR occur and renewed focus on what can be done to prevent the "too-many events" they discovered.

Daniel Cook

Improving Patient Care Limits Malpractice Suits

Improving a facility's quality of care may have as much of an impact on lowering the number of medical malpractice lawsuits as tort reform does, a new study suggests.

The study looked at the number of liability claims filed between 2000 and 2006 in a multi-hospital healthcare organization with locations both in Texas and Louisiana. In both states, the number of liability claims decreased over the study period, though for different reasons, researchers from the Southern Illinois University School of Medicine say.

In Texas, the average monthly medical liability claims per quarter began at 7.27 at the start of the study. In 2003, Texas introduced tort reform legislation designed to make it more difficult for patients to file malpractice claims, resulting in a sharp decline. By 2006, researchers found that the average number of claims dropped to 1.4 per quarter.

However, in a similar hospital demographic in Louisiana — which did not enact tort reform laws designed to limit medical malpractice claims — researchers also saw a decline of liability claims between 2000 to 2006. They found that this decrease in claims correlated with an increase in hospital quality scores based on 22 CMS measures.

The researchers suggest that providers can reduce their liability with or without tort reform. "Improved quality without increased financial burden (and, therefore, improved patient care and outcomes) results in a decrease in medical liability claims," they note, "that should further emphasize the ultimate goal of increasing patient care, patient outcomes, and quality improvements when considering medical reform."

Kendal Gapinski

AMA Votes to Set Age-Related Guidelines for Docs

The time has come, says the American Medical Association, to establish criteria to determine whether physicians in their 60s, 70s and beyond are still competent to continue practicing. What those criteria will be has yet to be determined, but the AMA has adopted a plan to figure it out.

At the group's annual meeting in Chicago last week, members voted to develop preliminary assessment guidelines that would include evaluations of physical and mental health, along with reviews of patient treatments. "Unfortunate outcomes may trigger an evaluation at any age," says a report issued by the AMA's Council on Medical Education, "but perhaps periodic reevaluation after a certain age, such as 70, when incidence of declines is known to increase, may be appropriate."

The report notes that since 1975 the number of physicians age 65 or older has quadrupled to about 240,000. "Physicians should be allowed to remain in practice as long as patient safety is not endangered," says the report, adding that creating guidelines "may head off a call for mandatory retirement ages or imposition of guidelines by others." It notes that age-related changes in hearing, vision, memory and motor skills can all affect competence, but says no evidence directly links those changes to poorer patient outcomes.

However, it concludes somewhat ominously, that while some physicians think they know when it's time to retire, evidence suggests otherwise.

Jim Burger

InstaPoll: When Do You Tell Patients to Arrive For Surgery?

When do you tell patients to arrive for surgery? Thirty minutes before their scheduled start time? Ninety minutes? It's always a balancing act between making patients wait too long before getting them ready for surgery, and waiting for patients due to schedule changes and cancellations. Finding the right time to bring patients in to accommodate both is always a challenge. Tell us in this week's InstaPoll how long before their scheduled starts you have patients present for surgery.

We know credentialing is a major headache, and there's a chance that not every license or certificate is current in a few of your physicians' credentialing files. About one-fourth (25%) of the 182 respondents to last week's poll say their surgeons' credentialing files are incomplete. The results:

Are your surgeons' credentialing files current?

  • No, they're a real mess! 6%
  • No, a few items are missing from a few files. 19%
  • Yes, they're all current and up to date. 75%

Dan O'Connor

News & Notes
  • The benefit of bundles against SSIs A bundled antimicrobial intervention that included nasal screening for methicillin-resistant or -susceptible Staphylococcus aureus, decolonization with intranasal mupirocin and chlorhexidine gluconate bathing, and a vancomycin / cefazolin or cefuroxime antibiotic prophylaxis before surgery resulted in a decreased incidence of surgical site infections following hip and knee replacement surgeries, according to a recent JAMA study.
  • Anesthesia's adverse effects on young brains Children who underwent general anesthesia before they turned 4 exhibited impaired language comprehension, lower IQ scores and adversely affected brain tissue composition, say researchers from Cincinnati Children's Hospital Medical Center in a study published online in the journal Pediatrics. "Although causation remains unresolved," they write, "these findings nonetheless warrant additional research into the phenomenon's mechanism and mitigating strategies."
  • How do you sleep? Irregular work hours and fragmented sleep patterns can endanger your patients' care and safety, say researchers. "Insomnia decreases empathy in healthcare workers," they write. "There is an urgent need to address this issue as it can lead to adverse clinical outcomes and medical errors." They presented a study on their findings at the recent annual meeting of the Associated Professional Sleep Societies.