Spinal surgery and patient safety: a systems approach.

In every spinal procedure, identifying the specific patient, proper surgical site, and pathologic lesion for surgical intervention are crucial patient safety concerns. The 1999 Institute of Medicine report "To Err is Human" identified adverse events associated with surgery. Both the American Academy of Orthopaedic Surgeons and the North American Spine Society have had voluntary, systems-based programs in place for several years to address wrong patient, wrong procedure, and wrong site surgery. Beginning July 1, 2004, the Joint Commission on the Accreditation of Healthcare Organizations mandated that hospitals comply with the JCAHO Universal Protocol. In addition to surgical site marking, the protocol incorporates additional factors, such as calling a time out before skin incision to do a final systems check of patient identification, surgical site, records, imaging studies, equipment, and review of preoperative medication.