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Key Points

  • image Medical error ranks as the third leading cause of death in the United States when defined to include system errors.

  • image One form of medical error is unnecessary or excessive medical care, which represents 21% of medical care administered in the United States.

  • image New peer-comparison metrics evaluate appropriateness of surgical care by measuring a physician’s practice pattern among all the physician’s patients benchmarked to the physician’s peers.

  • image Judicious opioid prescribing upon discharge after surgery is critical given the magnitude of the opioid crisis.

  • image The structure-process-outcome framework within the context of an organization’s culture helps to clarify how risks and hazards embedded within the organization’s structure may potentially lead to error and injure or harm patients.

  • image Poor communication contributes to approximately 60% of the sentinel events reported to The Joint Commission.

  • image Operating room briefings are team discussions of critical issues and potential hazards that can improve the safety of the operation and have been shown to improve operating room culture and decrease operating room delays.

  • image National Quality Forum surgical “never events” include retained surgical items, wrong-site surgery, and death on the day of surgery of a normal healthy patient (American Society of Anesthesiologists Class 1).

  • image The most important determinant of malpractice claims against a surgeon is patient rapport, not undertesting.


Patient harm due to medical mistakes can be catastrophic, resulting in high-profile consequences for the patient, surgeon, and image institution. A single error can even destroy a surgeon’s career. While mistakes are inherent to human nature, it is becoming more recognized that many mistakes are preventable.

Patient safety is a science that promotes the use of evidence-based medicine and local wisdom to minimize the impact image of human error on quality patient care. Wrong-site/wrong-procedure surgeries, retained sponges, unchecked blood transfusions, mismatched organ transplants, and overlooked allergies are all examples of potentially catastrophic events that can be prevented by implementing safer hospital systems. This chapter provides an overview of the modern-day field of patient safety by reviewing key measures of safety and quality, components of culture, interventions and tools, assessment methods, risk management strategies, and a selected review of common complications in surgery.

Medical Care Gone Wrong

Today, there are more medications, diagnoses, procedures, and handoffs performed than ever in the history of medicine. Moreover, overtreatment is now an endemic problem in some areas of healthcare. With more medical care being delivered, there are naturally more opportunities for things to go wrong. In fact, harm may be associated with complexity. The Commonwealth Fund reported that the United States leads the world in medical errors, observing that 34% of patients with health problems in the United States report experiencing medical, medication, or test errors—the highest rate of any nation, and an analysis suggests that the problem of medical care gone wrong, i.e., medical errors including systems errors, may rank as the third leading cause ...

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