Published 8/1/2015
William J. Robb III, MD; Dwight W. Burney III, MD

Tackling Surgical and Patient Safety NOW

None of us comes to work intending to harm patients. Yet, our work is inherently dangerous to our patients, our coworkers, and ourselves. Is a safe surgical environment something we can assume? If not, what can we do to make surgery safer for all?

The Institute of Medicine defines safety as “freedom from accidental injury.” The National Patient Safety Foundation expands this to include “ ... avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of care.” Patient safety can be viewed as a philosophy, a discipline, and an attribute of the system of care.

Patient safety is one of six overarching priorities in the National Quality Strategy. The AAOS believes that safety is a prerequisite for quality (and thus value). As Daniel Wolterman, president and CEO of Memorial Hermann Hospital (Houston), says, “Ensuring patient safety is our core value, and it’s our only core value.”

Confusing and contradictory articles have appeared in the surgical safety literature during the past few years. Making sense of all this is difficult. What exactly is safety for the orthopaedic surgical patient? Is the Safe Surgery Checklist worthwhile or not? Why do wrong site and wrong patient surgeries still occur?

Recent orthopaedic-specific surgical safety literature gives cause for concern. According to the Agency for Healthcare Research and Quality (AHRQ) National Healthcare Quality and Disparities Report Chartbook on Patient Safety (2014), the overall adverse event rate for hip replacement patients was 6.5 percent in 2012, and the rate increased for older patients (aged 75 to 84 years).

In a cross-sectional study of Medicare patients with conditions that required surgery, adverse event rates failed to decline between 2005 and 2011. A significant proportion of those patients underwent orthopaedic procedures.

Another study based on data from the National Surgical Quality Improvement Program found that 10 orthopaedic procedures accounted for 70 percent of adverse events in orthopaedic surgical patients.

Orthopaedic surgeons look to the AAOS as a trustworthy source of information and education. The Academy has sponsored or participated in multiple safety-related activities, including the Team STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) “Train the Trainer” and “Fundamentals” workshops and the current AHRQ/Health Research and Educational Trust Ambulatory Surgery Safety Orthopaedic cohort. In addition, the Academy is collaborating with the American College of Surgeons (ACS) to sponsor a 2016 National Surgical Patient Safety Summit. Many AAOS members are familiar with the ACS’s work in developing standards for cancer and trauma care; the goal of this collaboration is to develop similar standards for safe, highly reliable surgical care for orthopaedic patients.

With this article the AAOS Patient Safety Committee is launching a regular surgical patient safety (“Safety NOW”) column in AAOS Now. This column will provide overviews of broad topics (human factors, safety culture, safety science, and nontechnical skills for surgeons) along with case reports and “tips and tricks” for orthopaedic surgeons to become more effective leaders in surgical safety.

Safety is an active property of systems of care and cannot be assumed to be present; regulatory efforts alone are insufficient. A safe surgical journey for our patients requires our active commitment and leadership. We hope that this regular column will add to our colleagues’ armamentarium for providing safe surgical care.

William J. Robb III, MD, chairs the AAOS Patient Safety Committee; Dwight W. Burney III, MD, heads the committee’s Section on Safety Education.


  1. Wang Y, Eldridge N, Metersky ML, Verzier NR, Meehan TP, Pandolfi MM, et al: National trends in patient safety for four common conditions, 2005-2011. N Engl J Med 370;4. January 23, 2014:341–350.
  2. Schilling PL, Hallstrom BR, Birkmeyer JD, Carpenter JE: Prioritizing perioperative quality improvement in orthopaedic surgery. J Bone Joint Surg Am 2010 Aug 04;92 (9):1884–1889.
  3. Kuo CC, Robb WJ: Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety. Clin Orthop Relat Res 2013 Jun;471(6):1792–1800.