Wrong-sided surgeries are some of the most obvious and preventable medical errors. As a preventative measure, most surgeons have preoperative routines, such as initialing or marking the surgical site before the anesthesia is administered to the patient prior to a surgery. Numerous medical associations and experts nationwide vehemently stress that some type of preoperative routine is necessary in every operating room to prevent such devastating medical errors.
The Universal Protocol
One nationwide initiative to prevent wrong-sided surgeries and similar medical errors was created by The Joint Commission, a non-profit organization that accredits hospitals and clinics for preventing wrong site, wrong procedure, and wrong person surgery. The Joint Commission formulated a set of standards called the Universal Protocol, which is composed of specific steps or routines that medical staff should perform in order to prevent medical errors such as wrong-sided, wrong-site, and wrong-patient surgeries.
One type of preventative measure is for a surgeon to initial the site on the patient to be operated on. However, since the organization’s standards are not required by law, the implementation and adherence to such pre-operative routines varies significantly among medical specialties and hospitals.
The Universal Protocol lists a “time-out” as another type of preventative measure. A “time-out” is a final check just before a surgery begins, where surgical staff verify that the correct patient is about to undergo the correct procedure on the correct site. Unfortunately, “time-outs” and similar routines are sometimes performed as ‘just going through the motions’ to just establish that such routines were performed.
While most patients are not familiar with these types of preoperative procedures, this is not the case in a ongoing lawsuit filed by an Oklahoma surgeon against another Oklahoma surgeon in 2011.
Summers v. Smith
About two years ago, Dr. Craig Summers, an ear, throat and nose surgeon, chose Dr. Stewart Smith at Integris Baptist Hospital in Oklahoma City for a right-side laminectomy. Dr. Summers suffered from pain and weakness of his right leg that required a surgery to remove bone from his spine that was pinching the nerves in his back. He went into the surgery with the understanding that he was having a right-sided spinal surgery and signed consent forms that stated just that. But prior to the surgery, Dr. Summers stated that the hospital staff kept referring to his surgery as left-sided and he recalled correcting them by indicating that he was having a right-sided spinal surgery.
Unbeknownst to Dr. Summers, Dr. Smith claims to have used a left-sided approach (by making the incision on the left side of the spine) for the right-side surgery. Dr. Smith’s defense is that he did not state in the consent form that he was going to be using a left-sided approach because the potential confusion that could result among the staff and the patient.
To further complicate matters, Dr. Summers suffered from a complication of the surgery that required a second surgery. The radiologist who read the post-operative MRI noted a “left sided laminectomy,” but later changed his finding when he was told about Dr. Smith’s technique. There is also another report indicating a surgical finding of a left laminectomy.
Four neurosurgeons, experts of Dr. Summers, concluded that it was a wrong-sided surgery, specifically referencing the MRIs taken before and after the surgery. Both parties are unwilling to settle, so the case is set for trial and a jury will decide.
Ways for Patients to Take Preventative Measures
Wrong-sided surgeries and procedures are likely to be more common than realized. Many studies rely on physicians and hospitals to voluntarily report how often these errors occur. But a patient who actively participates in the preoperative procedures can provide additional protection from error.
Patients can pay close attention to the informed consent documents, medical records, test results, and diagnostic x-rays and MRIs to ensure the consistency of the information throughout all the documents.
Additionally, The Joint Commission encourages patients to ask questions if a patient has any misunderstandings of their upcoming surgery. The organization’s ‘Speak Up’ campaign advocates patients to have a clear understanding of what is required of them in preparing for surgery and after surgery, such as medication dosages and limitations on physical activity.
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