To the Editor:
We welcome the article by Wong et al. (1) which has made a great contribution to the literature on patient safety in orthopaedic surgery. Similarly, across the Atlantic, key advances are being made to understand
patient safety. We are privileged to have the existence of the National Patient Safety Agency (NPSA). The Department of Health (UK) has been spearheading the patient safety agenda through the creation of the NPSA which has led to the development of the Reporting and Learning System
(RLS) database of patient safety incidents which are reported by all the hospitals in England and Wales (2). Running since 2003, this database is now the largest of its kind in the world, already having received over three million reports of episodes of care that could or did result in iatrogenic harm (3). Undoubtedly, the database has its limitations owing to its nature of being a self-reporting, voluntary system with a blame-free culture. There is a also a great deal of under-reporting. However,
important nuggets of information can be obtained.
The largest proportions of these patient safety incidents originate from medical specialties (34%), surgical specialties (15%), mental health (13%) and obstetrics and gynecology (10%).
Our top categories of patient safety incidents reported in trauma and orthopaedic surgery include patient accident (which includes collision with objects, contact with sharps, inappropriate patient handling or positioning and slips, trips and falls). These account for 18490/47229
(39.1%) incidents. Treatment and procedure account for 6960/47229 (14.7%), medication account for 3790/47229 (8.02%) and infrastructure (staffing, facilities and environment) account for 3183/47229 (6.7%) of the total burden of patient safety incidents.
We are trying to shift the paradigm of our database, which skeptics believe is limited, to warning, communication and detection of rare patient safety incidents such as bone cement implantation syndrome (4,5).
Our specialty demands the utmost expertise in treating insult to bone and the modern era demands that we apply the same expertise in understanding and mitigating against errors that could occur in trauma and orthopaedic surgery.
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
References
1. Wong DA, Herndon JH, Canale ST, Brooks RL, Hunt TR, Epps HR, Fountain SS, Albanese SA, Johanson NA. Medical errors in orthopaedics. Results of an AAOS member survey. J Bone Joint Surg Am. 2009;91:547-57.
2. Department of Health. High quality care for all: NHS Next Stage Review final report. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825.
Accessed 2009 Jul 16.
3. National Patient Safety Agency National Reporting and Learning Service. Patient safety incident reports in the NHS: National Reporting and Learning System Data Summary. Issue 11 (Feburary 2009) - ENGLAND. http://www.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=26473. Accessed 2009 Jul 24.
4. Vincent C, Aylin P, Franklin BD, Holmes A, Iskander S, Jacklin A, Moorthy K. Is health care getting safer? BMJ. 2008;337:a2426.
5. National Patient Safety Agency Rapid Response Reports. Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur. March 11, 2009. http://www.npsa.nhs.uk/nrls/alerts-and-directives/rapidrr/mitigating-risks-when-using-bone-cement-in-hip-surgery/. Accessed 2009 Jul 24.
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