Discuss the below:
Introduction to Healthcare Quality Management
Critical concept (Description of Wrong-Site Surgery Event)
A 62 year-old man had an arthroscopy procedure performed on his left knee instead of his right knee. Three weeks prior to the surgery, the orthopedic clinic telephoned the hospital to schedule the man's procedure. At that time, the front office staff in the clinic mistakenly scheduled a left knee arthroscopy (the wrong knee). The surgery scheduling clerk at the hospital faxed a surgery confirmation form to the clinic. Per hospital policy, the clinic is supposed to review the information on the form, verify the accuracy, and fax the signed confirmation back the hospital. Meanwhile, the clinic staff was busy and did not fax the confirmation back. On the day of surgery, the patient's paperwork indicated that the surgery to be performed on his left knee, per the original phone call from the clinic. The surgery schedule, a document used to plan the day's activities in the operating area, also indicated that the patient was to have a left knee arthroscopy. The man was taken to the operative holding area, where a nurse spoke with him about his upcoming procedure. Relying on the surgery schedule, the nurse asked the patient to confirm that he was having an arthroscopy on his left knee. The man told the nurse that he had been experiencing pain in both knees and that he'd eventually need procedures on both of them. He thought he was scheduled for surgery on his right knee that day but that perhaps the doctor had decided to operate on his left knee instead. The nurse did not read the history and physical examination report that the patient's doctor brought to the hospital that morning. If she had read this report, she would have noticed that it had right knee surgery scheduled that day.
The anesthesiologist examined the patient in the preoperative holding area. When asked about the procedure, the man was confused about which knee was to be operated on that day. The anesthesiologist wrote "knee arthroscopy" in his note in the patient's record. The patient was taken to the operating room, where the surgeon was waiting. The surgeon spoke with the patient about the upcoming procedure on his right knee, and the patient signed the consent form indicating that surgery was to be performed on the right knee that day. The surgeon marked his initial on the man's right knee in ink to designate the surgery site.
The anesthesiologist and scrub nurse readied the room for the procedure. The patient was anesthetized and fell asleep. Thinking the man was having surgery on his left knee; the nurse placed a drape over his right knee, not noticing the surgeon surgeon's initials. The left knee was placed in the stirrup and prepped for the procedure. The nurse then asked everyone in the room to confirm that the man was the correct patient and that he was having an arthroscopy on his left knee. Everyone in the room said. "yes" except the surgeon, who was busy preparing for the procedure. Distracted, he nodded his head in agreement. The nurse documented on the preoperative checklist that patient's identity, procedure, and surgery site had been verified. The surgeon performed the arthroscopy on the knee that had been prepped-the left one. When the patient awoke in the surgery recovery area, he asked the nurse why he felt pain in his left knee and told her the procedure should have been performed on his right knee. The nurse notified the surgeon, who immediately informed the patient and his family about the mistake.
Critical Concept 8.2 is a description of a wrong-site surgery event. An arthroscopy should have been performed on the patient's right knee, but the procedure was done on his left knee. The Root cause analysis (RCA) team for this event comprises the people directly involved in the procedure (surgeon, anesthesiologist, surgical nurses, and surgery scheduling clerk) and the managers of the admission and surgical areas. The team's first task is to determine what happened by collecting and inspecting physical evidence (such as equipment, materials, and safety devices) and reviewing documentary evidence (paper or electronic media). The team also asks the people directly and indirectly involved in the event to provide their perspectives on the event.
Read the description of the wrong-site surgery event in Critical Concept 8.2 and the root causes identified by the team that conducted the RCA. Conduct a literature and Internet search for risk reduction strategies aimed at preventing wrong-site surgeries. Which of these strategies would help prevent a similar event from occurring at the hospital described in Critical Concept 8.2?
Use the most current information in the Health CareHealth Care Cost and Utilization Project ( https://hcupnet.ahrq.gov) database to answer the following questions:
What is the national average length of hospital stay and average hospital costs for patients with the following diagnoses?
Abdominal pain
Acute myocardial infarction
Chronic obstructive pulmonary disease and bronchiectasis
Diabetes mellitus with complications
What is the average length of hospital stay and average hospital costs for patients who underwent the following procedures?
Cesarean section
Hip replacement, total and partial
Hysterectomy, abdominal and vaginal
Percutaneous coronary angioplasty (PTCA)