Operating on the left side instead of the right is not frequent in France. A checklist must be completed for each operation to limit errors.
- Each year, 30 to 50 statements are filed with insurance companies regarding a side error.
- Since 2010, the operating theater teams must complete a checklist intended to limit these medical errors.
- In fact, only 27% of establishments are beyond reproach in terms of identity-vigilance.
- In most hospitals, patient identification is a recurring flaw.
The error is enough to leave you speechless. And it is expensive for the hospital which is at the origin. The JC Blair Memorial Hospital in Huntingdon (United States) must pay 810,000 euros ($ 900,000) in damages to Steven Hanes.
In 2013, the 54-year-old man underwent testicular surgery for chronic pain. But the surgeon took the wrong side, removing his right organ.
Chance of the calendar, another “side error” made the news. This time in France. In Reims (Marne), an 18-month-old child was operated on for a left inguinal hernia in early 2016… when it presented on the right side. A second intervention made it possible to repair the damage, but the parents of the baby are considering filing a complaint.
A checklist
The news is episodically rich in the matter. But in reality, side errors are rare. This only concerns one intervention out of 15,000 to 30,000, according to a report from the High Authority for Health (HAS) published in 2012. Over the year, this represents 30 to 50 declarations to insurance companies, quantified the French Society of Anesthesia and Resuscitation (SFAR) in 2014.
These rates remain low thanks to various measures put in place by the French health authorities. And this, from 2010. On this date, the HAS set up a mandatory checklist. It is inspired by that proposed by the World Health Organization.
Mistakes Avoided
This document details the verification process at the different stages of hospital care, from induction of anesthesia to discharge from the operating room. Nurses and surgeons must therefore ascertain, from the patient and in his medical file, which part of the body must be operated on.
In practice, the usefulness of the checklist is confirmed. This is evidenced by a case study published on the HAS website. Experts describe the case of Denis, 43, suffering from an inguinal hernia in his groin. His doctor is on the wrong side in the letter referring him to the hospital. Thanks to the list, the error is detected early enough. The good side is operated.
Mark the patient
Another method is increasingly used in the operating room: mark the operating site with an indelible marker. Using a universal symbol, as part of a formalized procedure, the teams indicate to the surgeon the area to be operated on. This makes it possible to avoid serious errors … or to identify its author. Because the person who marks the site is identified in the documents.
However, this practice remains in the minority. In 2014, the HAS published the results of a survey of 9,000 accredited doctors. 40% of them systematically carried out the marking of the site, seeing it as an additional security tool. But the other practitioners appealed to their “freedom of appreciation” and considered the number of barriers “already significant, even excessive”.
Overconfidence
Health professionals err on the side of overconfidence by refusing any labeling of patients. Because in this area, the establishments have great efforts to make. Already in 2012, the HAS placed patient identification among the 5 recurring problems in hospitals.
Five years later, the situation still leaves much to be desired. In his mid-term review published in June, the HAS still points to the identification faults. “Investigations by patient-tracer still too frequently confirm non-compliance with the rules for verifying or tracing the identity of the patient,” scolds the health agency.
In fact, only 27% of establishments do a correct job. For the others, the main elements of the identity-vigilance process are not respected.
.
