“Thousands” of Errors Made by Surgeons

From Skeptical Scalpel, originally posted 12/24/12

Over the last few days, stories about “thousands of errors made by surgeons” have received a lot of media and Internet attention. All of this was the result of a paper from Johns Hopkins that says surgeons leave an object in 40 patients per week, perform wrong site surgery on 20 patients per week and perform the wrong operation altogether in 20 patients per week.

Photo by Army Medicine

Photo by Army Medicine

The paper reported 9,744 such errors in a review of the National Practitioner Data Bank over the 20 years from 1990 to 2010. I’d love to tell you how they extrapolated from 9,744, which over 20 years averages 9.4 such errors per week, to 80 per week, but the paper is not accessible to those who do not subscribe to the journal Surgery.

I agree with those who say these are “never” events that are totally preventable and should never happen.

But I want to set the record straight.

Listen to me. Surgeons are not the cause of sponges being left in patients. I’ll explain.

A surgeon is about to perform an appendectomy. Before she arrives in the operating room, the circulating nurse and the scrub technician will have assembled all of the equipment needed to do the case. They also will have carefully counted all of the instruments, needles and sponges. [The “sponges” are not like the ones you use to clean your sink. They are 4 X 4 inch gauze pads or larger cloths called lap (short for “laparotomy”) pads.]

The surgeon has nothing to do with the counting either before or at the end of the surgery. As the wound is being closed, the nurse and tech perform another count to verify that all sponges etc. are accounted for. A third count is done after the skin is closed. There are checklists for this.

When I protested on Twitter that surgeons were being blamed for the errors involving objects left in patients, many people responded that if I was in charge, I should verify that the counts were correct. I replied that I could either do the surgery or do the counting, but not both. You see, as the case progresses, I might have asked for more equipment or a suture that was not on hand at the start of the case. The staff must add these things to the total count. If a new package of lap pads was opened, they must be counted before they can be used. Would you want your surgeon to look away from your bleeding wound to count the sponges?

Others brought up the alleged “fact” that the surgeon is the “captain of the ship.” That principle, which was established in Pennsylvania law in 1949, has been abandoned by most states. Here is a quote from a textbook on nursing malpractice:

“The viability of this doctrine is dubious, at best, in today’s health care system. Each perioperative health care provider is considered a professional with responsibility and hence accountability for specified tasks and individual actions.”

Many more such references can be found.

By the way, I wanted to see how the prestigious Johns Hopkins Hospital, which is where the authors of the paper work, is dealing with medical errors. However, when I searched the Leapfrog patient safety website, this is what I found for Johns Hopkins Hospital.

Attempts to solve the problem of retained objects with technology such as barcoding sponges or placing radio frequency tags on them have not caught on. And those measures would not be able to help with instruments or needles.

Yes, no object should ever be left in a patient. But at least get the headlines straight. If nurses and techs do their jobs, surgeons cannot leave things in patients.

OnSurg thanks Skeptical Scalpel for permission to re-post his blogSkeptical Scalpel tweets at @Skepticscalpel

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