Background. There has been widespread interest in medical errors since the publication of ‘To Err is Human’ by the Institute of Medicine in 1999. The Patient Safety Committee of the American Academy of Orthopaedic Surgeons has compiled results of a member survey to identify trends in orthopaedic errors that would help direct quality assurance efforts. Methods. Surveys were sent to 5,540 Academy fellows; 917 were returned (response rate 16.6%) with 53% (483/917) reporting an observed medical error in the last 6 months. Results. A general classification of errors showed equipment (29.0%) and communication (24.7%) errors with the highest frequency. Medication errors (11.4%) and wrong site surgery (5.6%) represented serious potential patient harm. Two deaths were reported, both involving narcotic administration errors. By location, 78% of errors occurred in the hospital (surgery suite 54%, patient room/floor 10%). The reporting orthopaedic surgeon was involved in 60% of the errors, nurses in 37%, another orthopaedic surgeon in 19%, other physicians in 16% and housestaff in 13%. Wrong site surgeries involved the wrong side 59%, another wrong site (e.g. wrong digit on the correct side) 23%, the wrong procedure 14%, on the wrong patient 4% of the time. The most frequent anatomic location was the knee and fingers/hand (both 35%), the foot/ankle 15%, followed by distal femur 10% and the spine 5%. Conclusion. Medical errors continue to occur and therefore represent a threat to patient safety. Quality assurance efforts and more refined research can be addressed towards areas with higher error occurrence (equipment, communication) and high risk (medication, wrong site surgery)

The aim of this study was to prospectively assess the results of a preoperative surgical safety checklist by comparing the initial phase of implementation of the Time Out Procedure (TOP) to the results four years later. We compared the accuracy and acceptance of the TOP to determine whether surgical practice had changed. The TOP was initiated for all elective surgical procedures performed in Christchurch in 2004. An initial audit from September 2004 – April 2005 (Phase 1) was compared to one from October 2008-September 2009 (Phase 2) looking for an improvement in completion of the procedure. Variances were recorded and analysed within the categories of 1 System and process 2 Consent and limb marking 3Incorrect details and 4 Near miss. A questionnaire was also sent to all the surgeons to determine their attitude towards the TOP. Although the TOP was completed more often in Phase 2 (98%, p<0.001) there were more variances (9%, p<0.001). The commonest variance was due to the surgeon and assistant not being present at the TOP which was significantly worse than in Phase 1 (p<0.0001). The results of the surgeon questionaire showed that only 88% agreed that the TOP was valuable in preventing wrong site surgery. This surgical indifference to the TOP is difficult to explain especially when National and International agencies have stressed its role in preventing surgical error. The recent introduction of the expanded WHO Checklist should be ‘surgeon led’ to be effective