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Chaudhry H, Nadeem S, Mundi R. Clin Orthop Relat Res. 2021;479(1):47-56.
The COVID-19 pandemic has dramatically increased the use of telehealth across various medical specialties.This systematic review did not identify any differences in patient or surgeon satisfaction or patient-reported outcomes with telehealth for orthopedic care delivery as compared to in-person visits.However, the authors note that the included studies did not adequately capture or report safety endpoints, such as complications or missed diagnoses.

Rickert J, Lee MJ. Clin Orthop Relat Res. 2013-2021.

This quarterly commentary explores a wide range of subjects associated with patient safety, such as the impact of disruptive behavior on teams, the value of apologies, and safety challenges due to COVID-19. Older materials are available online for free.

A 40-year-old man with multiple comorbidities, including severe aortic stenosis, was admitted for a pathologic pelvic fracture (secondary to osteoporosis) after a fall. During the hospitalization, efforts at mobilization led to a second fracture of the left femoral neck The case describes deviations in the plan for management of anesthesia and postoperative care which ultimately contributed to the patient’s death.

American Society of Anesthesiologists, American Academy of Orthopaedic Surgeons. Pain Alleviation Toolkit.  March 12, 2020.

Communication and shared decision-making are fundamental tactics to guide clinical team and patient efforts to minimize the potential for prescription opioid misuse. This tool kit includes modules for providers that outline practice and communication strategies to help with postoperative pain. Patient and family materials in the kit focus on safe medication disposal and instructions for tracking pre- and post-surgery pain levels.
Barbanti-Brodano G, Griffoni C, Halme J, et al. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2019.
Checklists are one tool for improving communication and reducing risk of adverse outcomes. The World Health Organization Surgical Safety Checklist has been previously studied in various surgical specialties; this study sought to determine its effectiveness in spinal surgeries. The authors conducted a retrospective analysis comparing the incidence of complications pre-checklist and post-checklist in a single center and found a significant reduction in the overall incidence of complications after the introduction of the checklist.
A woman with a history of prior spine surgery presented to the emergency department with progressive low back pain. An MRI scan of T11–S1 showed lumbar degenerative joint disease and a small L5–S1 disc herniation. She was referred for physical therapy and prescribed muscle relaxant, non-steroidal anti-inflammatories, and pain relievers. Ten days later, she presented to a community hospital with fever, inability to walk, and numbness from the waist down. Her white blood cell count was greater than 30,000 and she was found to be in acute renal and liver failure.
During surgery for a forearm fracture, a woman experienced a drop in heart rate to below 50 beats per minute. As the consultant anesthesiologist had stepped out to care for another patient, the resident asked the technician to draw up atropine for the patient. When the technician returned with an unlabeled syringe without the medication vial, the resident was reluctant to administer the medication, but did so without a double check after the technician insisted it was atropine. Over the next few minutes, the patient's blood pressure spiked to 250/135 mm Hg.
An elderly man with a complicated medical history slipped on a rug at home, fell, and injured his hip. Emergency department evaluation and imaging revealed no head injury and a left intertrochanteric hip fracture. Although he was admitted to the orthopedic surgery service, with surgery to fix the fracture initially scheduled for the next day, the operation was delayed by 3 days due to several emergent trauma cases and lack of surgeon availability. He ultimately underwent surgery and was discharged a few days later but was readmitted several weeks later with chest pain and shortness of breath.
Horn SR, Liu TC, Horowitz JA, et al. Spine (Phila Pa 1976). 2018;43(22):E1358-E1363.
This retrospective review of National Surgical Quality Improvement Program data on hospital-acquired conditions following elective spine surgery found that 3% of these cases had at least one hospital-acquired condition. The most common conditions were surgical site infection, followed by urinary tract infection and venous thromboembolism, all well-recognized conditions with known evidence-based prevention strategies.
Dy CJ, Osei DA, Maak TG, et al. The Journal of bone and joint surgery. American volume. 2018;100:1902-1911.
Overlapping surgery is a controversial practice in which an attending surgeon performs more than one procedure concurrently. This retrospective cohort of overlapping orthopedic surgeries across five academic institutions found no differences between complication rates for overlapping versus nonoverlapping procedures. The authors recommend individualizing decisions regarding overlapping surgeries.

Azar FM, ed. Orthop Clin North Am. 2018;49(4):A1-A8,389-552.

Quality and value have intersecting influence on the safety of health care. Articles in this special issue explore key principles of safe orthopedic care for both adult and pediatric patients. Topics covered include leadership's role in implementing sustainable improvement, postsurgery patient education as a safety tactic, and the impact of surgical volume on safe, high-quality care.
Gagliardi AR, Ducey A, Lehoux P, et al. BMJ Quality & Safety. 2017;27.
Regulatory agencies rely on physician reports of adverse events associated with medical devices in order to identify safety concerns. This qualitative interview study found that most physicians who implant devices do not regularly report adverse events related to particular devices. The authors recommend that postmarketing surveillance of medical devices be redesigned to foster detection of adverse events.
Anoushiravani AA, Sayeed Z, El-Othmani MM, et al. The Orthopedic clinics of North America. 2016;47:689-95.
High reliability organizations have developed methods for achieving safety despite hazardous conditions. This review explores the importance of establishing a culture of safety and leadership commitment to achieve high reliability in health care. The authors discuss the benefits of applying high reliability principles in orthopedic practice to standardize approaches and prevent wrong-site surgery.
Black KP, Armstrong AD, Hutzler L, et al. The Journal of bone and joint surgery. American volume. 2015;97:1809-15.
This review examines safety in orthopedics, including how to determine effective safety metrics and teach residents about quality and safety. The author recommends establishing a culture of safety that promotes error prevention, teamwork, transparency, and continuous learning for educators as well as trainees.
Menendez ME, Janssen SJ, Ring D. BMJ quality & safety. 2016;25:25-30.
Trigger tools facilitate detection of adverse events in medical records, which enables more efficient record review. This study identified adverse events following outpatient orthopedic surgeries using a trigger tool. There was an overall adverse event rate of 10%, suggesting significant improvements are needed in this ambulatory surgery setting.
Abelson J; Saltzman J; Kowalcyzk L; Allen S.
Scheduling concurrent surgeries can have negative effects on staff and patients. This investigative news article explores the practice of overlapping procedures at a leading hospital, potential risks associated with double-booked cases, lack of transparency with patients involved, as well as the potential impact on patient safety.
Bruinsma WE, Becker SJE, Guitton TG, et al. Clinical orthopaedics and related research. 2015;473:1582-9.
This study sought to examine hazardous attitudes—behaviors determined to contribute to traffic accidents among college-aged drivers by the Federal Aviation Administration and the Canadian Air Transport Administration—in orthopedic surgery. More than one-third of surgeons had at least one score correlated to increased likelihood of automobile collision. The authors did not find an association between these behaviors and surgeons' perception of safety culture. They suggest that future work should explore whether such hazardous attitudes predict surgical outcomes or complications.
Pujol N, Merrer J, Lemaire B, et al. Orthop Traumatol Surg Res. 2015;101(4):399-403.
Trigger tools are a useful method to screen for adverse events. To determine whether unplanned return to surgery could be utilized as a trigger for detecting errors, this study assessed rates of such incidents in an orthopedic and traumatologic surgery department. Using an approach similar to prior studies of delayed diagnosis, researchers examined a retrospective case series of orthopedic and trauma surgeries in which a revision procedure occurred. They found a relatively low incidence of unplanned return to surgery, but their clinical review indicated that half of such cases represented preventable complications. The authors advocate for a registry of unplanned return surgeries as a patient safety improvement strategy.