The Joint Commission on Accreditation of Health Care Organizations unveiled today a detailed protocol to prevent "wrong surgery," which includes wrong-site, wrong-procedure and wrong-person procedures.
The protocol becomes part of accreditation standards on July 1 of next year, and parts of it already have been incorporated into standards, JCAHO officials said in a press conference in Chicago, near their Oakbrook Terrace, Ill., headquarters.
The protocol includes verifying who the patient is, guidelines to mark the site and making sure the entire surgical team takes a "time out" just before the operation to discuss possible errors, they say.
In addition to being approved by the JCAHO board of commissioners in the summer, the new protocols have been endorsed by more than 40 healthcare organizations, including the AMA, American Hospital Association, American College of Physicians, American College of Surgeons and American Academy of Orthopaedic Surgeons, the JCAHO reports.
JCAHO officials and representatives of the endorsing organizations at the press conference said feedback about the protocol has been overwhelmingly positive, and objections from surgeons have diminished in the many years it took to develop it.
Some of the surgeons' chief objections, they say, are that the protocol slows down those with a high-volume of cases, is unnecessary for surgeons with no malpractice suits filed against them and marking the site can reduce patients' trust in their surgeon.
But JCAHO officials say the accreditor is not allowing exceptions from the protocol, though it will allow for some flexibility in the way hospitals, ambulatory surgery centers and other JCAHO-accredited institutions carry them out.
Arnold Zeal, M.D., chief of neurosurgery at Baptist Medical Center in Jacksonville, Fla., told the press conference that he realized wrong-site surgery can happen to anyone when it happened to him. He says he approached a lumbar disc operation from the wrong side several years ago.
Although he operated on the right side within an hour and no significant damage was done, "I could not understand how this could have happened," he says. Since then, he adds, "I became acutely aware of the need for protocols to prevent this from happening again."
JCAHO President Dennis O'Leary, M.D., says many hospitals are still a long way from adopting the full protocol.
For example, 36% of organizations surveyed by JCAHO this year were not marking the surgical site, O'Leary says. The organization reports there have been 52 reported cases of in the three categories of wrong surgery so far this year.
"By using this protocol we can basically eliminate this problem," said Thomas R. Russell, M.D., executive director of the American College of Surgeons, at the press conference.
James Herndon, M.D., president of the American Academy of Orthopedic Surgeons, says similar protocols adopted in the 1990s by the academy lowered the incidence number of malpractice cases for orthopedic surgeons at one carrier.
O'Leary added he does not think that JCAHO actions against hospitals that do not use the protocol would not markedly increase their exposure to malpractice lawsuits. "That exposure exists today," when a mistake is made public, he added.
Surgeons asking questions about the protocol at the press conference focused on how it deals with marking the operative site. The protocols in that one area include points such as:
- make the mark near the incision site;
- use a "permanent" marker so that the mark does not disappear during the procedure;
- the person performing the procedure should do the marking; and
- final verification of the mark should take place in the "time out" just before the operation.