Medical errors plague every specialty

October 15, 2005

Sometimes physicians, nurses, pharmacists, and other health-care providers make mistakes. A few statistics generated by the Institute of Medicine, the Centers for Disease Control and Prevention, and others highlight the problem.

How big a problem is this for us ophthalmologists? In the JCAHO study just cited, there were no documented claims for wrong-site surgery for ophthalmology. When I searched http://Google.com/ for "medical errors" and a number of medical specialties, I found the number of hits varied considerably. Using PubMed, the online citation search engine, the number of publications was much lower, but the variability among specialties was also present.

Seriously, this issue of medical errors and patient safety has taken on new significance to me since my dean publicly announced last year that Johns Hopkins Hospital would dedicate itself to do whatever was necessary to be the safest hospital in the world. With tens of thousands of drug dosages administered every day, 99.9% or even 99.99% accuracy would no longer be adequate; we would need to aspire to ensure that every patient gets the correct dosage of the correct medicine at the correct time, or the correct surgery on the correct side, and this would need to happen every single time. A large component of the compensation of department directors like me is now determined by results of measures of patient safety within our departments.

Based upon the JCAHO data, plus my own little analysis of searches on Google and PubMed, do we conclude that ophthalmologists are experts when it comes to patient safety? Or, perhaps related to the heavily outpatient orientation of our specialty, is it that our errors are less likely to be recognized and reported? Certainly I have heard prominent ophthalmologists recount errors with programming cylinder axis at the time of LASIK (so that postoperatively the patient had a doubling of preoperative cylinder) and implantation of the wrong-power IOL. My suspicion is that errors in ophthalmology are much more common than a literature review would suggest, but that these errors are not reported and published for a number of reasons (embarrassment, worries about lawsuits, etc.).

As a resident, I heard about one of my professors being called to the phone to talk to an ophthalmologist in another city. This ophthalmologist told my professor that he had just removed the wrong eye of a patient with a large choroidal melanoma! The patient was still under general anesthesia, the family was in the waiting room, and the ophthalmologist asked my professor what he should do-then burst into tears. How often does wrong side eye surgery occur or wrong IOL implantation occur in real life? I doubt that anyone knows.

To guard against this, at my institution we require that the side of the eye having surgery be marked with the surgeon's initials prior to bringing the patient into the operating room, and that a "time out" occur in the operating room before surgery begins, with everyone agreeing on the identity of the patient, the procedure that is to be done, and the eye(s) to be operated upon.