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Evidence-Based Safe Surgical Practices as Adjuncts to the Universal Protocol

Jason Adelman, MD, MS; Johanna Chelcun, MHS, PA-C
Arch Surg. 2011;146(4):489. doi:10.1001/archsurg.2011.62.
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Further analysis demonstrated that 100% of the errors resulting in wrong-patient procedures and 48.6% of the errors resulting in wrong-site procedures had communication as a root cause. Interestingly, these errors equally affected both surgical and nonsurgical patients.

In their discussion, Stahel et al1 emphasized the importance of “readbacks” and strict adherence to the Universal Protocol, but they missed the opportunity to raise awareness of the roles played by the World Health Organization (WHO) surgical safety checklist and medical team training for invasive procedures. Although the Universal Protocol is based on expert opinion, there is no significant evidence to demonstrate its benefit. The WHO surgical safety checklist and medical team training, on the other hand, have been shown to significantly reduce morbidity and mortality in the operating room, and both are used to prevent the same types of errors as the Universal Protocol.2,3 Further research is needed to better understand their effectiveness in preventing errors associated with wrong-site procedures and wrong-patient procedures, but the patient safety benefits of these approaches are clear. Because the briefings, debriefings, and teamwork emphasized in these approaches are a valued addition to the steps in the Universal Protocol, the Association of Perioperative Registered Nurses has developed a comprehensive surgical checklist that combines the Universal Protocol and the WHO surgical safety checklist to maximize their benefits.4

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April 1, 2011
Philip F. Stahel, MD; Philip S. Mehler, MD; Ted J. Clarke, MD
Arch Surg. 2011;146(4):489-490. doi:10.1001/archsurg.2011.63.
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