Unplanned return to theater: a quality of care and risk management index?
Approach to Improving Safety
Setting of Care
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.