Surgical mistakes persist in Bay State: still a tiny fraction of total procedures.

Newspaper/Magazine Article

Surgical mistakes persist in Bay State: still a tiny fraction of total procedures.

November 7, 2007

Kowalczyk L.

View more articles from the same authors.

This article investigates the causes of surgical errors reported in recent years by Massachusetts hospitals, and identifies team training and instrument bar-coding as solutions for improvement.

Free full text

Related Resources From the Same Author(s)

Surgical error at Tufts prompts widespread changes.

September 10, 2014

Brigham and Women's airing medical mistakes.

April 24, 2013

Many Mass. hospitals will pay for errors.

October 3, 2007

Beth Israel cited for improving obstetrics care.

April 11, 2007

MGH halts a pediatric program: Heart surgeries on hold after errors.

April 29, 2009

Beth Israel cited for residents' long hours—facing review for accreditation.

September 24, 2008

Hospitals try to calm doctors' outbursts: medical road rage affecting patient safety, group says.

August 27, 2008

Hospitals try to break a deadly 'code.'

December 14, 2005

Hospitals cutting nurses' long shifts.

September 28, 2005

Hospitals study when to apologize to patients.

August 3, 2005

Report faults Children's Hospital for medication errors.

June 6, 2018

Maternal deaths at MetroWest hospital prompt state probes.

August 9, 2017

Fires during surgeries a bigger risk than thought.

November 21, 2007

MGH death spurs review of patient monitors.

March 3, 2010

'Alarm fatigue’ a factor in 2nd death.

October 5, 2011

5 cataract surgeries, 5 people blinded: what went wrong?

August 24, 2016

Patient alarms often unheard, unheeded.

February 23, 2011

Five hospitals release data on inspections.

May 2, 2007

Doctors say they need protection to apologize.

November 14, 2007

Disclosure of medical mistakes is sought.

November 16, 2005

So much care it hurts: unneeded scans, therapy, surgery only add to patients' ills.

November 1, 2017

A guide for HCAs on safe patient transfers.

August 7, 2013

Behind one hospital's fight against deadly infection.

June 20, 2012

Hospitals move to reduce risk of night shift.

June 11, 2008

Hospitals tackle high-risk drugs to reduce errors.

March 19, 2008

Learning to ask tough questions of your surgeon.

January 23, 2008

Health-care industry agrees on patient safety rules.

November 15, 2006

To reduce risks, hospitals enlist 'proceduralists.'

July 25, 2007

Tackling tube misconnections.

July 11, 2007

Patients, families take up the cause of hospital safety.

June 6, 2007

Hospitals combat errors at the 'hand-off.'

July 12, 2006

Hospitals move to cut dangerous lab errors.

June 28, 2006

Video games can help cut surgical errors.

June 7, 2006

Hospitals target risks of color wristbands.

April 18, 2007

Patient, protect thyself.

February 14, 2007

New standards for hospitals call for patients to get private rooms.

April 5, 2006

Look-alike, sound-alike oncology medications.

March 22, 2006

Seeking a safer surgery: some states crack down on doctors who perform unregulated outpatient procedures.

August 5, 2009

'Sorry' is still the hardest word.

March 11, 2009

In just a flash, simple surgery can turn deadly.

March 4, 2009

Arrogant, abusive and disruptive — and a doctor.

December 17, 2008

The most crucial half-hour at a hospital: the shift change.

November 4, 2015

Hospitals find a way to say, 'I'm sorry.'

February 17, 2016

Don't come back, hospitals say.

June 22, 2011

Hospitals overhaul ERs to reduce mistakes.

January 30, 2005

'Use only as directed' isn't easy.

May 11, 2011

Can you read this drug label?

August 3, 2011

What if the doctor is wrong?

January 25, 2012

Diagnosis: doubled over in pain.

March 29, 2012

Clues to better health care from old malpractice lawsuits.

May 18, 2016

Bringing surgeons down to earth.

November 30, 2005

Global goal: reduce medical errors.

September 7, 2005

Drug errors show need for tech aid.

June 29, 2005

Patient safety and health information technology conference: A newsmaker interview with Carolyn M. Clancy, MD.

June 22, 2005

The cost of errors: Medicare's new policy could cost the average hospital $23,772: study.

June 25, 2008

A surgeon so bad it was criminal.

October 10, 2018

Soaring numbers of 111 callers forced to wait for a call back.

February 10, 2016

Fixing the medication reconciliation breakdown.

December 20, 2006

Suspicious insulin injections, nearly a dozen deaths: inside an unfolding investigation at a VA hospital in West Virginia.

October 23, 2019

Think you can't make medication errors?

April 10, 2013

Nurses seek to reduce long hours and fatigue.

February 11, 2015

Hospitals tally their avoidable mistakes.

August 5, 2009

Lay use of lasers fueling complications.

July 13, 2005

An Organisation with a Memory: Report of an Expert Group on Learning from Adverse Events in the NHS Chaired by the Chief Medical Officer.

March 6, 2005

I-PASS checklist: a powerful tool for patient handoffs.

October 24, 2018

The key to reducing doctors' misdiagnoses.

September 20, 2017

A better safety net for young doctors.

August 17, 2016

Health-care providers want patients to read medical records, spot errors.

June 25, 2014

Why hospitals want patients to ask doctors, 'Have you washed your hands?'

October 9, 2013

Why doesn't medical care get better when doctors rest more?

September 4, 2013

A medical detective story: why doctors make diagnostic errors.

October 7, 2015

Preventing the tragedy of misdiagnosis.

December 13, 2006

Hospitals boost patients' power as advisers.

August 22, 2007

Nurse error spotlights drug's danger.

June 28, 2006

Catching deadly drug mistakes.

January 27, 2010

Incentives push more doctors to e-prescribe.

February 4, 2009

Patients get power of fast response.

September 9, 2009

Hospitals own up to errors.

September 2, 2009

More families hear apologies following medical mistakes.

September 3, 2008

Aftercare tips for patients checking out of the hospital.

June 30, 2010

At the hospital, better responses to those beeping alarms.

January 13, 2016

Delivering results.

April 6, 2011

As doctors age, worries about their ability grow.

February 9, 2011

Seven (potentially) deadly prescribing errors.

November 11, 2015

A mismatch made in America.

June 19, 2019

Missed signals.

May 16, 2007

Patient misidentification in oncology care.

July 2, 2008

Is misdiagnosis inevitable?

April 13, 2016

Hospitals put pharmacists in the ER to cut medication errors.

June 18, 2014

Every Patient Tells A Story: Medical Mysteries and the Art of Diagnosis.

August 26, 2009

Small patients, big consequences in medical errors.

September 24, 2008

For patients, a list of hospital hazards.

January 14, 2009

To Err Is Human — To Delay Is Deadly.

June 3, 2009

Is incivility an underlying threat to safety in obstetrics?

February 18, 2015

Patient safety and adverse maternal health outcomes: the missing social inequalities 'lens.'

October 5, 2005

Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety.

May 12, 2010

Working Knowledge: How Organizations Manage What They Know.

September 14, 2005

Learning how to learn: compliance with patient safety alerts in the NHS.

August 3, 2005

Medicine Safety: Take Care.

February 27, 2019

Behind Human Error, Second Edition.

November 10, 2017

Related Resources

Deficiencies in Facility Leaders' Response to Critical Surgical Events at the Michael E. DeBakey VA Medical Center in Houston, Texas.

October 25, 2023

Investigation of urology intraoperative events leading to root cause analysis at national VA medical centers.

July 26, 2023

Identifying a list of healthcare 'never events' to effect system change: a systematic review and narrative synthesis.

July 12, 2023

Inside the preventable deaths that happened within a prominent transplant center.

June 28, 2023

Factors contributing to preventing operating room "never events": a machine learning analysis.

May 10, 2023

Patient Safety Authority Annual Reports.

May 1, 2023

Your Safety in our Hands in Hospital.

April 20, 2023

Insurance claims for wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors: a retrospective study for 10 years.

February 8, 2023

WebM&M Cases

To Dilute or Not Dilute: Drug Errors and Consequences in the Operating Room

October 27, 2021

Evaluating the impact of radio frequency identification retained surgical instruments tracking on patient safety: literature review.

August 18, 2021

WebM&M Cases

Two Cases of Retained Vaginal Packing: When Writing an Order is Not Enough

April 28, 2021

Common general surgical never events: analysis of NHS England never event data.

April 7, 2021

Using radiofrequency technology to prevent retained sponges and improve patient outcomes.

October 28, 2020

Patient Safety Primers

Never Events

September 7, 2019

Doctors can change opioid prescribing habits, but progress comes in small doses.

August 28, 2019

Surgeons' opioid-prescribing habits are hard to kick.

July 10, 2019

When is the surgeon too old to operate?

February 13, 2019

Perioperative medication errors: uncovering risk from behind the drapes.

January 16, 2019

Assessment of incorrect surgical procedures within and outside the operating room. A follow-up study from US Veterans Health Administration medical centers.

December 5, 2018

When doctors get the wrong patient.

October 5, 2016

Statement on the prevention of retained foreign bodies after surgery.

October 1, 2016

The role of radio frequency detection system embedded surgical sponges in preventing retained surgical sponges: a prospective evaluation in patients undergoing emergency surgery.

August 24, 2016

Advancing Patient Safety in Cataract Surgery: A Betsy Lehman Center Expert Panel Report.

June 15, 2016

When a surgeon should just say 'I'm sorry'.

April 6, 2016

Making checklists work: South Carolina's statewide experiment.

February 3, 2016

Do cell phones belong in the operating room?

August 5, 2015

When should surgeons stop operating?

July 1, 2015

Wrong-site surgery, retained surgical items, and surgical fires: a systematic review of surgical never events.

June 24, 2015

Wrong-site orthopedic operations on the extremities: the Pennsylvania experience.

March 25, 2015

How to make surgery safer.

February 25, 2015

See More About The Topic

Operating Room

Health Care Providers

Patients

Surgery

Identification Errors