Will video cameras in the OR decrease the rate of wrong-site surgery?

by Kristina Fiore, MedPage Today Staff Writer

Rhode Island Hospital, located in Providence, will pay $150,000 and install video cameras in all of its operating rooms after performing its fifth wrong-site surgery since 2007, according to the state’s Department of Health.

Will video cameras in the OR decrease the rate of wrong site surgery? The hospital will also have to open its ORs to an inspector who will observe surgical procedures and protocols for at least a year, the department said.

On Oct. 22, Rhode Island Hospital notified the Department of Health that it had performed a wrong-site procedure on a patient who was scheduled to have elective surgery on two different fingers of the right hand.

Both procedures, however, were performed on the same finger, according to a department report.

The hospital had been fined $50,000 in 2007 for errors in brain surgeries on three different patients and was reprimanded for a mistake in a cleft palate procedure last May.

In a letter to hospital CEO Timothy J. Babineau, MD, the department of health called the problem “frustrating” and said it “significantly damages the public’s perception of safety and the credibility of RI Hospital’s ability to consistently provide for safe surgical procedures.”

In a statement, Babineau said the hospital remains “committed to decreasing the frequency of medical errors including wrong-site surgery.”

Glenn Rothman, MD, chair of surgery for Banner Desert Medical Center in Mesa, Ariz., and a nationally quoted expert on the subject, said an error like the one at Rhode Island Hospital is “extremely hard to prevent” because the entire hand is dressed for surgery, and the structures are smaller and much closer together.

However, he said the overall incidence of wrong-site surgeries “appears to be unchanged, despite all measures introduced to prevent it.”

The hospital’s report of the error states that a nurse marked a straight line down the patient’s right forearm to the wrist rather than directly on the fingers because she didn’t know where, exactly, the incisions would be made and did not want to be reprimanded.

However, the surgeon did not verify the correct surgical procedures, including the site and side.

After performing both procedures on the same finger, other OR staff asked why the operation on the second finger had not been initiated. The surgeon checked with the family of the patient, and subsequently performed the surgery on the correct finger.

However, the team failed to conduct a mandatory “time out” — a protocol for confirming several surgery-related factors — between procedures, the report states.

On Oct. 26, the Department of Health issued the fine as well as the compliance order requiring every surgery at Rhode Island Hospital to be observed by a licensed clinical professional who isn’t part of the surgery team and who is trained to observe surgical site markings and time-out procedures.

That monitoring must continue for at least a year, the report states.

It also requires that every operating room at the hospital be equipped with video and audio monitoring equipment within 45 days, and that every doctor be taped performing surgery at least twice every year.

The hospital must also shut down elective surgery for one day and conduct a mandatory training and review of the uniform surgical procedures with all surgical staff.

It also has to immediately adopt and implement the state’s Uniform Surgical Safety Checklist and Standard Definition.

In the 2007 cases, neurosurgeons operated on the wrong part of the brain in three different patients.

And last May, according to a Department of Health report, a patient was scheduled for a right alveolar bone graft from the right hip to the right soft palate.

The surgeon started to operate on the left palate instead, potentially because a nurse documented the incorrect side on a written report, although the patient was marked correctly.

Rothman said the addition of cameras in the OR may do little to curb wrong-site surgeries.

“I’m not aware of any data that show that works,” he said. “Would cameras in the cockpits of planes reduce pilot error?”

Rather, a revamping of “time-out” standards from the Joint Commission on Accreditation of Healthcare Organizations’ Universal Protocol may be in order, he said.

They’ve been “diluted” to include multiple factors to assess during a time-out, while they used to focus solely on three principles — correct patient, correct site, and correct surgery, Rothman said.

“You have to simplify your checks and balances in order to make them effective,” he said. “If you’re making people pay attention to more tasks, there’s more opportunity for error.”

He noted that there is not universal acceptance that the time-out policy as it stands “prevents or reduces errors.”

The OR should also be more team-oriented, he said, with other staff feeling empowered to speak up if they notice a problem.

“Even the person who is lowest on the perceived totem pole of education and training in the room has the same responsibility to pay attention and to speak up if they have any concerns,” Rothman said. “There’s no reason a junior person can’t recognize [a mistake], but the environment may be intimidating.”

Visit MedPageToday.com for more hospitalist news.

Comments are moderated before they are published. Please read the comment policy.

  • SarahW

    The cameras will help; there will be less temptation to skip procedures when actions are recorded and observed. There is less chance of a “lets not but say we did” culture surviving as there is no longer a prospect of getting away with shortcuts (as many times the shortcuts have advantages, and no harm results, making it tempting to gamble and skip steps that reduce the probability of mistakes.)

  • Rezmed09

    In the future, maybe every OR and every ER and every clinic will have a camera for documentation of events. If the priority is to document what happened this will become more common. I can’t imagine the effect it will have on providers. We will need much more training on legalize.

  • ninguem

    Can we install them in the administrative offices?

  • AnnR

    That sounds like a hospital to be avoided.

  • Matt

    Cameras would seem to alleviate a lot of the second guessing physicians hate.

  • Sue

    “Glenn Rothman, MD, chair of surgery for Banner Desert Medical Center in Mesa, Ariz., and a nationally quoted expert on the subject, said an error like the one at Rhode Island Hospital is “extremely hard to prevent” because the entire hand is dressed for surgery, and the structures are smaller and much closer together
    ARE YOU KIDDING ME ?!! And this is the nationally quoted expert?
    4 yrs college> 4yrs medical school> @ least 3 yrs residency and this is the surgeon you get? Excuses?!
    I worked with surgeons for 30 yrs. The issue is Orthopedic & Plastic surgeons in particular like to book the maximum cases allowed in a day, then start adding on” urgent” cases. They demand to go between 2 operating rooms with everything they desire. . Administration bends over backwards and treat them like “rock stars” because they generate income. Often they intimidate the team, so the nurses do not dare challenge them. I have seen it tried and the nurses were severely penalized. The good outcome was they were forever banned from that surgeons room. We had an anesthetist who also had a law degree, Orthopedic surgeon went to Administration about having a lawyer in his OR. She was banned, he tried to have her staff privileges revoked, but Administration @ that moment was more afraid of her promise of definite suit then his temper tantrum. These surgeons want to run case to case, they do not review permits or surgical sites with patients, time is money. All these things set the climate for errors. Wrong surgical site is impossible to hide,other errors are called patients bad protoplasm. Anyone with some time @ a Surgicenter if honest, knows this to be true. Of course this is a generalization, but common enough practice in both these specialties to result in many, many, Surgical meetings. The only way to control their income is to crank out procedures is the reason these surgeons presented to us .A Plastic surgeon once asked our group to work Saturdays for him to help pay his legal fees!! Rhode Island Hospital is the one who got caught. They will be better for it. Sorry this is so long and totally unlike me. I never speak out, but this “expert’s” excuse really pushed my buttons!

Most Popular