![]() ![]() 19 A review of regional blockade complications revealed 7 wrong-site blocks in 23,271 cases for a wrong procedure rate of 1 per 3,324 cases (or 30.1 per 100,000 cases). For hand surgeons, the approach yields a wrong surgery rate estimate of 1:27,686 cases ( i.e., 3.6 wrong surgeries per 100,000 cases). 18 Another approach is to extrapolate from surgeon self-reporting. The accompanying editorial asserted a rate of 1 wrong surgery per 5,000 cases ( i.e., 20 wrong surgeries per 100,000 cases) that was reported confidentially by multiple community hospitals. 17 This estimate was critiqued as being too heavily influenced by hospital efforts to resolve these events informally to avoid the stigma of reporting. 16 For example, indemnity payments from a large self-insurance trust indicated a rate of 1:112,994 cases (95% CI, 1:76,336 to 1:174,825). While wrong surgery incidence estimates and estimate methods vary, they may be increasing. 8, 11, 12 “Fully implemented” checklists have minimal OR efficiency impact and can reduce the cost per surgical procedure 13 but often suffer from variable and unreliable use. 8–10 Examples of poor reliability include the following: teams do not initiate the checklist, teams perform the checklist from memory, the team responds without looking at the checklist, items are skipped or incorrectly/incompletely performed, and incorrect initiation timing. 6, 7 However, checklist interventions must be performed reliably to be successful, which depends on excellent reliability of the team. 4, 5 In the perioperative environment, the universal protocol, including preprocedure verification, site marking, and a hard stop time-out ( i.e., a checklist to review the surgical plan), was created and first widely promulgated by the Joint Commission (JC) after its 2003 wrong-site surgery summit to intercept wrong surgeries before incision. 2, 3 Recently, studies have challenged checklist complication reductions, finding no decrease in overall adverse event rate, but still found significant benefits in decreasing overall and infectious adverse events. ![]() Two notable applications of checklists dramatically reduced the frequency of injury or death from complications that had previously been frequent. ![]()
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