Rhode Island Hospitals Adopt Process to Limit Surgical Error

July 2, 2009

All 14 hospitals in Rhode Island have agreed to adopt a uniform set of precautions to prevent surgeons from operating on the wrong body part or committing other grievous errors.

Doctors and hospital officials said Tuesday that following the same procedures before surgeries — no matter which hospital they are working in — will improve communication and reduce the potential for errors. The new protocol will begin Wednesday.

The Hospital Association of Rhode Island said the hospitals voluntarily agreed to the protocol.

The new steps include having two licensed providers mark the place on the patient where the operation is to occur and requiring surgeons to mark the spot with their initials and use a checklist before surgeries.

The goals are to help doctors who work at multiple hospitals and reduce the potential for operating on the wrong part of the patient or other mistakes.

“At the core of this issue is the patient and the outcome, patient safety,” said Diane Siedlecki, president of the Rhode Island Medical Society. “There is no more fundamental principle to the physician community.”

William Cioffi, surgeon-in-chief at Rhode Island Hospital, said standardizing the steps just before surgery ensures the surgeon is responsible for the procedure and communicates with his staff.

“It’s also important, especially in a small state where many physicians work in several hospitals, to have a policy which is consistent across hospitals,” Cioffi said.

Development of the protocol began 18 months ago, before several wrong-site surgeries at Rhode Island hospitals occurred, said Jean Marie Rocha, vice president of clinical affairs for the hospital association.

Rhode Island Hospital, following its fourth wrong-site surgery in the past two years, signed an agreement with the state Department of Health in May to reform its practices. The hospital was fined $50,000 and ordered to make changes in 2007 after three brain surgeons operated on the wrong side of a patient’s head.

Director of Health David Gifford said the state’s hospitals willingly collaborated on the new protocol.

“We saw a few wrong-sided surgeries and the community recognized a need to get together,” Gifford said.

Members of the group that worked to develop the protocol said they are also working to make it easier to report near misses. A recent near miss came when Miriam Hospital officials reported a surgeon put local anesthetic in the incorrect eye of a patient scheduled for eye surgery on June 11.

A statement from the hospital said staff had marked the correct side. The error was found before surgery started, and the procedure is being rescheduled.

“It was a good catch,” said Kathleen Hittner, president and CEO of Miriam Hospital. “Wrong-site surgery was averted, so I think that was a very good process.”

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