Introduction

Wrong-side surgeries (WSS) continue to be a common occurrence in spite of our very best preventive efforts.In the state of Pennsylvania alone one case of WSS is reported every week. Most people, however, believe that these numbers are much higher as in many places, the information is not reported, especially if there is no harm done as in the case of a wrong sided ureteroscopy (especially if it is followed by the correct one). It is also estimated that many WSS’s that occur in ambulatory surgical centers and office-based surgical centers are often not reported. These events should not be happening in this day and age and have therefore been termed “NEVER EVENTS”. The importance of preventing these so-called Never-events cannot be over-stated. In 2018, the Joint Commission for accreditation of hospital made the prevention of Wrong-side surgeries one of its major priorities. This declaration by the Joint Commission as well as some very high-profile and well publised WSS cases has led many hospitals and Ambulatory surgical centers to adopt the so-called Comprehensive surgical checklist (the Joint commission and/or the WHO checklists) and the “Time-out” prior to the start of surgery. While these measures have helped to reduce the number of these so called “Never events” they continue to occur quite frequently even when properly implemented. As in the case of a recent high profile case involving wrong kidney surgery, the “Time-outs” have also been also criticised as basically officially announcing an error about to be made! There are multiple reasons why these so called never events continue to occur with such frequency. These include errors made by clerical and nursing staff as well as physician and physician extenders. Most often, the patient is either incapable or shut-out of the process of determining the side and site of surgery. Even when nurses are unsure of the site and side of surgery, they worry about the repercussions of pointing out what may be an impending surgical error. The most common reason, however, is that once an error has been made by one person, be it a clerical member of staff, a nurse, a Physician Assistant or the Surgeon, everybody else down the line copies and goes along with the same mistake. If a patient is scheduled for a Right knee replacement (when actually the Left knee was the diseased knee), often everyone assumes that what was scheduled was correct and this error that started well before the patient ever arrived the hospital continues into the operating room and could lead to a surgical error. In 2017, a group was formed, made up of Patient advocates, Nurses, Clerical staff, Surgical physician extenders, Insurance companies, computer programmers and specialists in Artificial intelligence and machine learning, Malpractice lawyers, Surgeons and Anesthesiologists. The purpose was to study the causes of WSS and to come up with ways of making these so called Never-Events truly Never events. The consortium recommended that institutions adopt a culture of ‘Speaking-up’ in case of concern as well as an algorithm for independent Verification of surgical sites in order to prevent errors from being “copied” from one member of the team to the next. The result of the second recommendation is the pre-surgery site check ®

SOFTWARE SOLUTION

Pre-surgery site check ® is a computer software that necessitates independent verification by various surgical team members, while making it impossible for one team member to be aware of what the other member is decided was the surgery side and site, . It is designed to be easy, straight -forward, non-time consuming and very effective. Only in cases of complete concordance of All team members will the surgery be allowed to proceed. The large in-room dashboard makes it very evident when there is any likelihood of a WSS occurring. Each facility determines how many independent verifications are necessary for the verification process to be deemed satisfactory for surgery to proceed. Each team member takes full responsibility for their role in the prevention of WSS. The lead role is taken by the Operating room nurse, who co-ordinates all the players and is the only one who can authorize the start of surgery. It also keeps track of near-misses and of any team members whose verification could have led to WSS and hence corrective measures are taken. The large in-room dashboard also provides a very easy and quick verification of pertinent information regarding the on-going surgery , as well as necessary pre-set reminders such as redosing of antibiotics and rechecking of blood sugars. The use of Artificial intelligence and machine learning means that fewer corrections and changes need to be made to individual surgeons preferences. For example, once a particular antibiotic is used for a particular procedure, the computer will bring that up as it antibiotic of choice whenever that particular procedure is selected. It will also automatically adjust to the time for redosing of antibiotics etc.

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