Healthcare Quality News

Poor communication was the most common cause of wrong-site, -side, and -person, surgeries at the Veterans Health Administration (VHA), reports American Medical News.

According to the American Medical News article, communication failures such as poor handoff of critical information between surgical team members are the leading cause of surgeries involving the wrong patient, the wrong side, the wrong body part, the wrong implant or the wrong procedure.

Poor communication was the cause of one in five adverse events reported to the Veterans Health Administration system from 2001 to 2006, according to a study published in November's Archives of Surgery. Problems during the perioperative timeout process were a root cause of errors more than 15% of the time.

(SOURCES: HCPro Patient Safety Monitor, http://hcpro.com, December 16, 2009; American Medical News, http://ama-assn.org, accessed December 22, 2009)