Surgeons Get Timeout to Prevent Mix-ups

"Timeouts" may be helpful in keeping kindergarten classrooms orderly. But now they're being translated to the operating room.

The aim? To avoid mix-ups at U.S. hospitals that can result in lost limbs or even death. Beginning today, accredited hospitals must ensure that each surgery begins with a "timeout" to verify the patient's identity, the procedure to be performed, and the site of the procedure.

The new "timeout" requirement is part of a three-pronged pre-operative process meant to ensure that each of the 70 million surgeries is being performed on the right body part of the right person.

As many as 98,000 Americans die each year as a result of medical errors, the eighth leading cause of death for Americans, exceeding AIDS, breast cancer and motor vehicle accidents, according to a 1999 Institute of Medicine report. And that's a "conservative estimate," says Dr. Robert Wise, vice president at the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, which has developed the new protocol.

While similar policies have been implemented at individual hospitals, the new protocol is the first instance of such an initiative being standardized on a national scale. Hospitals must follow it to receive Medicare reimbursements.

Wrong Site Surgery

A common and significant medical error occurs when surgeons operate on the wrong part of the body. Instead of amputating the left leg, for instance, the surgeon removes the right.

According to Wise, there are no hard-and-fast data on the incidence of wrong site surgeries specifically, and the overwhelming majority go unreported. But a voluntary medical error database maintained by the organization has shown an alarming number of wrong site errors each year, and the numbers only seem to be increasing, with 75 reported cases in 2003.

While this trend may also reflect doctors' increasing willingness to disclose errors, the statistics were striking enough to prompt JCAHO to convene a summit last year for the purpose of developing this protocol.

"We should not have been receiving any reports," insists JCAHO spokesman Mark Forstneger. "Wrong site surgery is intolerable, it's preventable."

According to Forstneger, the incidence reports showed that "one of the main problems was communication issues, in particular with continuum of care." The multiple hand-offs as a patient goes through admissions, gets lab work done, and is prepped for surgery provide ample opportunity for "communication errors to crop up if redundancies [are] not put into place," says Forstneger.

Another major issue addressed by the new protocol is lack of consistency with pre-operative procedures across hospitals. Says Wise, "There was disagreement [between hospitals] if the right leg was marked because that was the one you should operate on, or the left leg because that was the one you should not operate on." Doctors working at multiple hospitals had trouble, he says.

Communication Is Key

Although the protocol is already implemented to varying degrees in most major hospitals, JCAHO-accredited institutions were given one year to formally comply with the regulations. Most say they find it a manageable and worthwhile process.

Dr. Gabriel Aldea, a cardiothoracic surgeon at the University of Washington, says that at first, there was concern among surgeons, since the new procedure seemed like "a waste of time" for surgeons who "know what we're doing."

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