In front of the entire class: Surgical success rates

Dr. Harvey Cushing became the father of brain surgery, following his surgical residency at Yale in the late 1890s. He attributed his success to meticulous care, rather than innovations per se. One key to his success was meticulous record-keeping. It started when he was assisting with surgery as a student, using a sponge to administer ether, and the patient died in front of the entire class. Appalled and mortified, Dr. Cushing and a classmate soon developed "ether charts," to keep track of a patient’s heart and respiration rates, perhaps his first major contribution to medicine. Such charting revolutionized surgery by greatly curbing complications and deaths from anesthesia, according to the Journal of Neurosurgery.

Since Dr. Cushing's era, anesthesia is the field of medicine where doctors have most greatly reduced their error rates. The systematic collection of their data and the scrutiny of it by those empowered to change medical practice saved many lives. Doctors in other fields also now record information on their success rates. It's time for this information to become routinely available to consumers. In Massachusetts, a legislative bill to require surgeons to provide some basic information to consumers is under consideration.

Advice: Find out the success rates for your surgery and your surgeon before you go under the knife.

Read another story about such transparency of surgical data. Thanks to Richard Conniff for the source story in the January/February 2011 issue of the Yale Alumni Magazine.

Its third wrong-site surgery this year: Errors in brain surgery

The Rhode Island Department of Health reprimanded a Rhode Island hospital yesterday, and fined it $50,000, for its third wrong-site surgery this year. Doctors at the hospital had performed four wrong-site surgeries in six years, all involving brain surgery.

An 82-year-old man was in the neurosurgical intensive care unit (ICU) for brain surgery on Friday. A CT scan had shown bleeding on the left side of his brain. A resident (a physician in training) began drilling into the right side of the patient's head. The resident realized the mistake, closed the initial incision, and performed the procedure on the left side.

As a result of the latest incident, all intra-cranial neurosurgical procedures will have an attending physician present for the entire procedure, hospital officials said.

Advice for patients at teaching hospitals: Add and initial a note on your patient consent form that requires a real physician to accompany the resident throughout your surgical procedure.

Browse for related stories in the index at the very bottom of this page, or read another wrong site brain surgery story at the same hospital three months ago.

Thanks to Liz Kowalczyk for the source article in today's Boston Globe.

The neurosurgeon relied on memory, not the CT Scan: Wrong site brain surgery

An 86-year old man, who has not been identified, came to the emergency department at a hospital in Rhode Island on July 30 with increasing lethargy three days after a fall. A CT scan indicated he had bleeding on the left side of his brain, and he was transferred to the operating room for surgery to drain the blood.

A nurse practitioner did not record which side needed surgery in the patient’s medical history nor on the consent form signed by the patient’s relative.

When a different nurse — a circulating nurse in the operating room — pointed out that the information was missing, the surgeon wrote down the side where he would operate on the consent form.

The surgeon didn’t confirm his memory by checking the CT scan, health inspectors found. He wrote down the wrong side on the form, and then cut open the wrong side. When he realized his error, he operated on the correct side.

The patient 86-died Saturday, and the medical examiner's office is still trying to determine whether the surgical error contributed to his death.

The hospital's chief quality officer said that the staff's sense of urgency about caring for the patient had superseded the rules.

Of course, as the quality officer added, emergencies are "exactly where policies and procedures need to be as tight as possible."

Cooper said that she believed someone in the operating room had questioned whether the correct side was being cut, but the surgeon was confident he was right.

Advice: Elderly hospital patients should bring an advocate.

Read another wrong side surgery story, or read more from the source article by Felice Freyer in the August 24 issue of the Providence Journal.

Jay Leno’s Advice

"In an interview with USA Today, Senator Barack Obama says the shortness of his political resume is his greatest strength. Politics is the only business where people brag about how little experience they have. Can you imagine guys saying to you: “Look, I’ve never been to medical school, I’ve never even watched 'E.R.,' but if you just let me try and do this brain operation I’ll do the best job I can.”?"

(Quoted in the New York Times yesterday.)

They dismissed her concerns: A misdiagnosis story

A ten-year-old disabled girl has died in the hospital amid claims that doctors misdiagnosed her condition.

Ayesha Wyatt died in Alder Hey Children's Hospital in Liverpool in the early hours of Tuesday morning with her mother at her bedside.

Ayesha’s mother claims that doctors dismissed her concerns that a plastic shunt removing harmful fluids from her daughter's brain had become blocked when the child's neck swelled up last month.

Advice to parents: You know your child better than anyone; you are their primary care provider. Keep the courage of your convictions when you see medical professionals disregard a key sign about your child. Go to a higher authority in the hospital if you think the doctors and nurses are making a serious mistake.

Read Darren Devine’s article, or read a story of a family advocate with a happy ending.