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Wrong-site surgery: Adopt the universal protocol

Medical Staff Leader Connection, December 8, 2003

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Dear Medical Staff Leader:

After years of discussion, debate, and procrastination, the American Academy of Orthopaedic Surgeons' (AAOS) position regarding "surgical-site marking" has changed. The AAOS partnered with over 40 health care organizations, including the JCAHO, to promote the universal protocol--a process that attempts to standardize procedures for verifying the correct patient, procedure, and surgical site. The protocol goes into effect on July 1, 2004, for all JCAHO-accredited hospitals, ambulatory care surgery centers, and office-based surgery sites.

Although most major medical and hospital organizations support the universal protocol, some physicians will be skeptical. Some may even be angered by it and argue that the protocol is an intrusion into the practice of medicine, that it is not their responsibility to mark the surgical site, or that the JCAHO should not determine the details of internal medical staff and hospital policies. However, don't let such protests distract your organization from the reason behind the universal protocol--the hundreds of patients who are harmed by wrong-site surgeries each year.

Medical staff leaders should demonstrate true leadership by calling for a complete review of the organization's current practices in regard to surgical-site marking. Compare existing policies to those defined in the universal protocol and ensure compliance with this proactive measure to better serve patient and physician interests.

Along the way, you may encounter colleagues who suggest that the universal protocol "is another example of cookbook medicine" or argue that your organization hasn't had a case of wrong-site surgery in years and "if it ain't broke, don't break it." Remind such naysayers that national standards regarding public safety have often worked when local solutions have failed. For example, three-pronged electrical plugs, consistently designed anesthesia equipment, public doors that swing out, common firefighting hose connections, etc. Clearly all hospitals and surgical facilities should adopt a standardized method of marking surgical sites.

Perhaps your staff and management team will benefit from reading "If it Ain't Broke, Break it," written by Robert J. Kriegel and Louis Palter (available in most business book stores, which provides ample rebuttal for those who wish to avoid progress and uniformity even when uniformity is warranted.

Surgical patients will thank the AAOS for their leadership in this area and so too should your organization.

That's all for this week.

All the best,

Hugh Greeley

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