Avoiding wrong site surgery: A systematic review

Spine

Volumn 35, Issue SUPPL. 9S, 2010, Pages

  Devine, John ^a   Chutkan, Norman ^b   Norvell, Daniel C ^c   Dettori, Joseph R ^c  

^a EISENHOWER ARMY MEDICAL CENTER   (United States)

^b MEDICAL COLLEGE OF GEORGIA   (United States)

^c Spectrum Research Inc   (United States)

Author keywords

Wrong level; Wrong patient; Wrong side; Wrong site

Indexed keywords

ARTICLE; HUMAN; MALPRACTICE; MEDICAL ERROR; NONHUMAN; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; RISK FACTOR; SPINE SURGERY; SYSTEMATIC REVIEW;

CHECKLIST; HUMANS; IATROGENIC DISEASE; INCIDENCE; MEDICAL ERRORS; NEUROSURGICAL PROCEDURES; PATIENT IDENTIFICATION SYSTEMS; POSTOPERATIVE COMPLICATIONS; PREOPERATIVE CARE; SAFETY MANAGEMENT; SPINAL DISEASES;

EID: 77951768022     PISSN: 03622436     EISSN: 15281159     Source Type: Journal    
DOI: 10.1097/BRS.0b013e3181d833ac     Document Type: Article

References (24)

1. JCAHO. "A follow-up review of wrong site surgery." 2001. Available at: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/ sea-24.htm.
2. Patient safety first alert-implementing a correct site surgery policy and procedure. Aorn J 2002;76:785-788
3. Levy D. No defense for wrong-site surgery. AAOS Bull 1998;46:18.
4. Canale ST. Wrong-site surgery: a preventable complication. Clin Orthop Relat Res 2005;433:26-29
5. NASS. Prevention of Wrong-Site Surgery: Sign, Mark & X-ray (SMaX). IL: LaGrange; 2001.
6. JCAHO. Universal protocol for preventing wrong site, wrong procedure, wrong person surgery. 2003. Available at: http://www.jointcommission.org/ PatientSafety/UniversalProtocol/.
7. Kwaan MR, Studdert DM, Zinner MJ, et al. Incidence, patterns, and prevention of wrong-site surgery. Arch Surg 2006;141:353-358
8. Meinberg EG, Stern PJ. Incidence of wrong-site surgery among hand surgeons. J Bone Joint Surg Am 2003;193-7.
9. Dettori JR, Norvell DC, Dekutoski M, et al. Methods for systematic reviews on patient safety during spine surgery. Spine 2010;35:S22-S27.
10. Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am 2003;85:1-3.
11. Ammerman JM, Ammerman MD, Dambrosia J, et al. A prospective evaluation of the role for intraoperative x-ray in lumbar discectomy. Predictors of incorrect level exposure. Surg Neurol 2006;66:470-3; discussion 473-474
12. Jhawar BS, Mitsis D, Duggal N. Wrong-sided and wrong-level neurosurgery: a national survey. J Neurosurg Spine 2007;7:467-472
13. Mody MG, Nourbakhsh A, Stahl DL, et al. The prevalence of wrong level surgery among spine surgeons. Spine 2008;33:194-198
14. Van Tulder M, Furlan A, Bombardier C, et al. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 2003;28:1290-1299
15. West S, King V, Carey TS, et al. Systems to Rate the Strength of Scientific Evidence. Evidence Report/Technology Assessment No.47 (Prepared by the Research Triangle Institute-University of North Carolina Evidence-based Practice Center, Contract No. 290-97-0011). Rockville, MD: Agency for Healthcare Research and Quality; 2002.
16. Seiden SC, Barach P. Wrong-side/wrong-site, wrong-procedure, and wrongpatient adverse events: are they preventable? Arch Surg 2006;141:931-939
17. Adverse Health Events in Minnesota. Minnesota: Department of Health, 2007.
18. Giles SJ, Rhodes P, Clements G, et al. Experience of wrong site surgery and surgical marking practices among clinicians in the UK. Qual Saf Health Care 2006;15:363-368
19. Gibbs VC. Patient safety practices in the operating room: correct-site surgery and nothing left behind. Surg Clin North Am 2005;85:1307-19, xiii.
20. Wong DA, WattersWCIII. To err is human: quality and safety issues in spine care. Spine 2007;32(11 Suppl):S2- 8.
21. Nassr A, Lee JY, Bashir RS, et al. Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degeneration? Spine 2009;34:189-192
22. Clarke JR, Johnston J, Finley ED. Getting surgery right. Ann Surg 2007;246: 395-403; discussion 403-405
23. JCAHO. Lessons learned: wrong site surgery. 1998. Available at: http:// www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea-6.htm.
24. Goodkin R, Laska LL. Wrong disc space level surgery: medicolegal implications. Surg Neurol 2004;61:323.