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back to the 1990s questioning the existing practices. One of the more interesting
papers is by Kaplan etal. from 1985, where the authors reviewed the data on
routine preoperative testing done on 2000 patients scheduled to undergo elective
surgery [5]. The authors found that 60% of the routinely performed tests would
not have been done if indications were part of the decision-making process.
More astonishing is the fact that only 0.22% of these tests actually revealed an
abnormality that could inuence the anesthesia and/or surgical plan; and to make
things worse, a review of the charts conrmed that none of these small number
of abnormalities were actually acted upon and none of them had any effect on the
outcome. In another study from 1997, the authors reviewed the records of 1044
patients who underwent surgical or diagnostic procedures at the Mayo Clinic in
1994 without any preoperative laboratory tests within a timeframe of 90days
prior to the procedure [6]. The authors found that there were no deaths, and only
17 intraoperative laboratory tests were required, with three of them being eventually abnormal. None of the perioperative laboratory tests changed the patient
management in any manner.
As with most things in life, the truth lies somewhere in the middle. That is to
say, neither the policy of multiple, routine preoperative laboratory testing, nor
the one of no testing at all, may be the best for patients. Essentially, using the
best available evidence, we have to decide which tests are needed for a specic
patient, based on the overall anesthesia evaluation. This brings us to our next
question.
2. Who do we need to test preoperatively? How do you decide? There are several
different ways of deciding which patients need to be tested, some better than
others. Physicians, and perhaps surgeons more so, are creatures of habit and of
the “n = 1” phenomenon. Specically, given the fact that “habit” essentially
provides a feeling of safety, it is not unusual to get the following responses to the
question of why does this patient need to do preoperative testing: “Because that’s
our routine” or “Because that’s what we always do” or “Because the chief resident told us to do that.” The “n=1” phenomenon has to do that frequently, and
despite any literature to the contrary, our decisions are inuenced by the last case
that had a complication. Obviously, this is not optimal and begs the question of
how do we choose between existing guidelines originating from different specialties (e.g., surgery, anesthesia, subspecialties), and who is the one developing
hospital policies (physicians, administration) and with what criteria (purely
medical, medico-legal, medico-economico-legal). Just as this discussion
becomes increasingly more confusing by creating more questions than answers,
we have to remember to get back to the basics in order to make an evidencebased decision.
The answer to the question of who should get preoperative evaluation is rather
simple: ALL patients scheduled for surgery should undergo preoperative evaluation. However, here is where we need to be very clear that preoperative evaluation is NOT the same as preoperative testing. Specically, all patients scheduled
to undergo a surgical procedure, no matter how “small,” should be evaluated
preoperative either by their surgeon (e.g., if the plan is to use only local
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G. Tsoulfas
anesthesia) or by an anesthesiologist. However, the exact type and extent of the
evaluation varies depending on the extent of the procedure. For very low-risk
procedures, it may be enough to obtain a history and physical exam to conrm
the absence of any major medical issues or risk factors. In cases of minor procedures or surgery in a patient with no known medical history, it may be enough to
obtain the same information, even during a telephone interview or with the use
of telemedicine. In the case of a more complex procedure or surgery, or in the
case of a patient with comorbidities, then it is necessary to have the patient evaluated by an experienced physician to assess the risk and determine which tests
are necessary as part of the evaluation for this specic patient. The key point here
is that preoperative testing is indicated only if, as part of the preoperative evalu-
ation, the type of surgery or the patient’s overall condition and comorbidities or
abnormal ndings during the history and physical exam warrant a more detailed
assessment. Additionally, we should also be cognizant of the fact that apart from
having a clear indication for obtaining preoperative testing, we should also consider whether the result of such testing can affect the perioperative management
of the patient or mitigate the risks involved. Later in this chapter, the specic
indications will be analyzed according to the different organ systems.
3. Is preoperative testing a problem? As physicians we consider ourselves the big-
gest advocates of our patients, and as a result there is always the temptation to
think that there is no such thing as “overdoing” it when it comes to preoperative
testing for our patients. However, reality is very different, as we could be not
helping our patients or society. Preoperative testing overuse can lead to wasting
valuable resources, exposing our patients to needless blood work and procedures, creating anxiety for the patients and their families, and (always the bottom
line) costing over $30 billion per year in 1987 calculations [7–9].
4. How do we decide which patients to test preoperatively? Several efforts have
approached this question in an evidence-based manner to achieve consensus. One
example is the guidelines by the National Institute for Health and Care Excellence
(NICE). NICE was originally set up in 1999 as the National Institute for Clinical
Excellence, a special health authority, to reduce variation in the availability and
quality of treatments and care in the U.K.National Health System. In 2005, there
was a merger with the Health Development Agency, which led to increased
involvement in the development of public health guidelines.
Let’s examine under what circumstances should the “main” preoperative tests
be ordered, if at all. Specically:
Electrocardiogram (ECG): There are no prospective, randomized clinical
controlled trials regarding the utility of preoperative ECG and, as such, we are
lacking prospective, good-quality data on whether it is useful or not. There are
several studies of lower quality, such as retrospective reviews or case series, as
well as consensus statements, which are often conicting and complicated. It is
not surprising that the prevalence of an abnormal ECG increases with age, as
almost 75% of people older than 75years old have an abnormal ECG, given the
accumulated changes over time having to do with cardiac anatomy, function, and
conductivity [10]. Although the patients mentioned above may be asymptomatic,
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there is evidence suggesting poorer outcomes in patients with abnormal ECGs.
In a retrospective study of 23,036 patients who underwent 28,457 surgical procedures in the Netherlands, patients with abnormal ECG ndings had a greater
incidence of cardiovascular death compared to those with normal ECGs, with a
4.5 relative risk (3.3–6.0) of death [11]. This nding was much less evident in
patients undergoing low- or low-to-intermediate-risk surgery, as in these patients
the difference in the incidence of cardiovascular death between those with and
without ECG abnormalities was only 0.5%. Although recommendations from
several organizations such as the American College of Cardiology/American
Heart Association (ACC/AHA), the American Society of Anesthesiologists
(ASA), the European Society of Cardiology/European Atherosclerosis Society
(ESC/EAS) and others may vary and are often conicting, there seems to be
agreement that an ECG is warranted when: (a) there are signs and symptoms of
cardiovascular disease, (b) there is stable known cardiac disease, (c) there are
risk factors; and the surgery will be intermediate- or high-risk with revised cardiac risk index (RCRI) ≥ 1 [12–14]. On the other hand, ECG can be safely
avoided when the surgery and the patient are both low risk or in cases such as
cataract surgery. As always, there remain gray areas regarding the utility of
ECG.These include the combination of a low-risk patient who is scheduled to
undergo an intermediate-risk procedure or that of a patient with risk factors who
is scheduled to undergo a low-risk procedure.
Coagulation studies: There is indeed signicant pressure on this issue, given
the multitude of anticoagulation medications available (and continuously increasing), the complex nature of the hemostasis process with its numerous mediators
and different phases, the hereditary nature of several of these problems, and the
large number of available coagulation tests. Early literature on the topic supported
the use of prothrombin time (PT) and the activated partial thromboplastin time
(aPTT) as part of the preoperative assessment of the patient’s coagulation [15,
16]. However, what became apparent is that clinical history and physical exam
are more than adequate in terms of predicting bleeding or coagulation problems,
an opinion that is shared by the ASA and the British Committee for Standards in
Hematology [17–21]. Given all this, it is obvious that the history and the clinical
exam need to be very thorough and should include information such as family
history of coagulation problems, history of abnormal bleeding with other procedures or during various activities, and use of any anticoagulation medication.
Complete blood count (CBC): There should be a reason behind ordering a
preoperative CBC, which has to do either with the patient or with the type of
surgery. Specically, if there are clinical history or physical exam ndings suggestive of an abnormality, such as known cytopenia, a history of bleeding,
immunosuppressed state as in the case of medications or recent chemotherapy,
pallor or excessive or unexplained fatigue among others, then obtaining a CBC
could affect the management of the patient. Additionally, if signicant blood loss
is anticipated given the complexity of the surgery, or if there are existing
comorbidities (such as ischemic heart disease) that could affect the transfusion
threshold, then a CBC is justied.
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G. Tsoulfas
Electrolytes, creatinine, glucose: If a patient has renal failure or is on medications (i.e., diuretics, digoxin) that can lead to loss or retention of electrolytes,
or there is concern over the uid status of the patient, then testing for electrolytes
and creatinine can provide valuable information. The decision of whether or not
to include these tests is a matter of estimating the overall risk based on the combination of the complexity of the surgery (minor, intermediate, high-risk) and the
overall condition of the patient (ASA status; see Table2.2). So, ASA 1 or ASA
2 patients scheduled for a minor procedure do not need them, whereas ASA 3 or
ASA 4 patients scheduled for an intermediate procedure should be offered them.
Still, the gray areas remain, such as in the case of ASA 2 and intermediate procedure, where the overall risk for acute kidney failure needs to be taken into
consideration [21, 22]. Regarding blood glucose, there really is no good evidence for routine inclusion in the preoperative workup, other than what the history and physical might dictate.
Chest X-ray (CXR): Although the predictive value of the history and physical remains strong, a CXR is part of most preoperative evaluations. Interestingly
enough, although abnormalities are relatively frequent (10–20%), they inuence
the management of the patient in less than 3% of cases [23].
Liver function tests (LFTs): LFTs should be included as part of the preoperative evaluation only if there is suspicion of liver disease on the basis of the
patient’s history, physical exam, or any prior laboratory abnormalities [24]. In
such a case that LFTs are warranted, then it may be wise to obtain INR and creatinine as well, so that the patient’s model for end-stage liver disease (MELD)
score can be calculated. The latter is a useful indicator of the severity of the acute
or chronic liver disease, as well as predictive of mortality in the near future.
Pregnancy Testing: Unrecognized pregnancy when someone presents for an
elective, or even an emergency, procedure, can cause signicant clinical and
medico-legal problems. As such, the overall tendency is to err on the side of caution, unless the history and physical can fully exclude this possibility. However,
the literature to support such a strategy is rather limited and the argument is
based on the fear of missing a pregnancy. In a very interesting study from the
Mayo Clinic in Arizona, the authors reviewed the records of 8245 women with
preoperative pregnancy tests and identied 11 positive tests, of which six were
false positives [25]. Of the ve true positives, three decided to cancel elective
surgery, one had surgery under local anesthesia, and the other proceeded with the
procedure, as it involved a malignancy, and subsequently had the pregnancy terminated. The positive pregnancy test rate was 0.13%, which essentially meant
that the estimated cost for each of the true positive tests was around $49,000
[25]. The very low incidence of unrecognized pregnancies together with the sensitive nature of the topic led the ASA in a practice advisory for preanesthesia
evaluation in 2012 to declare “…the literature is inadequate to inform patients or
physicians on whether anesthesia causes harmful effects on early pregnancy.
Pregnancy testing may be offered to female patients of childbearing age and for
whom the result would alter the patient’s management.” [4].
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Geriatric population: The part of the population over the age of 65years
deserves special mention, as it represents a continuously increasing percentage
of the whole population with increased needs. There are several reasons for this
demographic change, including the baby boom generation crossing the 65-yearold threshold, decreased birth rates, and people living longer [26]. The American
College of Surgeons (ACS) National Surgical Quality Improvement Program
(NSQIP)/American Geriatrics Society (AGS) Best Practices Guidelines in
2012in an evidence-based manner presented guidelines regarding the preoperative assessment of the geriatric population, with special emphasis on the several
issues that are unique to the geriatric patient [26]. Specically, this includes
assessment of the cognitive ability and capacity of the patient, screening for
depression, identifying risk factors for postoperative delirium, documenting
functional status and risk of falls, determining baseline frailty score and nutritional status, obtaining a detailed medication history, and evaluating the family
and social support system, in addition to the standard history and physical.
25
Key Points
An overview of the topic helps identify certain critical points. Specically, with the
help of a thorough history and physical, we can avoid routine preoperative testing
for low-risk surgeries without a clinical indication. The reason is that if we tested
everybody, any ndings (and IF they were followed up appropriately) would inuence the management in under 3% of the patients tested. Additionally, in almost all
cases, there are no adverse outcomes when patients who are clinically stable undergo
elective surgery, irrespective of the testing. Examples of low-risk surgeries include
eye surgery, endoscopic surgery, supercial surgery, breast surgery, and most types
of ambulatory surgery. Also, patients who have no cardiac history and a good functional status do not require preoperative stress testing when scheduled to undergo
non-cardiac thoracic surgery.
Determining when to do preoperative anesthetic evaluation and testing has to do
with the clinical condition of the patient and the invasiveness of the procedure. For
a disease of high severity and a highly invasive procedure, it is best to always perform the evaluation before the day of surgery, whereas in a disease of low severity
and a less invasive procedure, the evaluation could be performed on the day of the
surgery.
It is extremely important to remember the following three key points:
1. ALL preoperative testing should be dictated and guided by the preoperative his-
tory and physical exam.
2. There are NO guidelines suggesting preoperative routine laboratory testing for
everybody.
3. Preoperative evaluation is NOT the same as preoperative testing; the latter
should take place only when indicated.
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G. Tsoulfas
Conclusion
In this chapter, we had the opportunity to review the decision-making process
involved (or at least that should be involved) in the preoperative evaluation, with
special emphasis on when and why to order preoperative testing.
References
1. Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, etal. The Department of Veterans
Affairs NSQIP: the rst national, validated, outcome-based, risk-adjusted, and peer-controlled
program for the measurement and enhancement of the quality of surgical care. National VA
surgical quality improvement program. Ann Surg. 1998;228(4):491–507.
2. Smetana GW.Preoperative pulmonary evaluation. N Engl J Med. 1999;340(12):937–44.
3. Mayhew D, Mendonca V, Murthy BVS.A review of ASA physical status—historical perspectives and modern developments. Anaesthesia. 2019;74(3):373–9.
4. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich
DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation,
Pasternak LR, etal. Practice advisory for preanesthesia evaluation: an updated report by the
American Society of Anesthesiologists task force on preanesthesia evaluation. Anesthesiology.
2012;116(3):522–38.
5. Kaplan EB, Sheiner LB, Boeckmann AJ, Roizen MF, Beal SL, Cohen SN, etal. The usefulness
of preoperative laboratory screening. JAMA. 1985;253(24):3576–81.
6. Narr BJ, Warner ME, Schroeder DR, Warner MA.Outcomes of patients with no laboratory
assessment before anesthesia and a surgical procedure. Mayo Clin Proc. 1997;72(6):505–9.
7. Katz RI, Dexter F, Rosenfeld K, Wolfe L, Redmond V, Agarwal D, etal. Survey study of
anesthesiologists’ and surgeons’ ordering of unnecessary preoperative laboratory tests. Anesth
Analg. 2011;112(1):207–12.
8. Lichtor JL, Johanson CE, Mhoon D, Faure EA, Hassan SZ, Roizen MF.Preoperative anxiety: does anxiety level the afternoon before surgery predict anxiety level just before surgery?
Anesthesiology. 1987;67(4):595–9.
9. Guttikonda N, Nileshwar A, Rao M, Sushma TK.Preoperative laboratory testing—comparison of National Institute of Clinical Excellence guidelines with current practice—an observational study. J Anaesthesiol Clin Pharmacol. 2019;35(2):227–30.
10. Strait JB, Lakatta EG.Aging-associated cardiovascular changes and their relationship to heart
failure. Heart Fail Clin. 2012;8(1):143–64.
11. Noordzij PG, Boersma E, Bax JJ, Feringa HH, Schreiner F, Schouten O, etal. Prognostic value
of routine preoperative electrocardiography in patients undergoing noncardiac surgery. Am J
Cardiol. 2006;97(7):1103–6.
12. NICE guideline [NG45]. Routine preoperative tests for surgery. 2016. https://www.nice.org.
uk/guidance/NG45. Accessed 2019 Nov 2010.
13. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, etal.
2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of
patients undergoing noncardiac surgery: executive summary: a report of the American College
of Cardiology/American Heart Association task force on practice guidelines. J Nucl Cardiol.
2015;22(1):162–215.
14. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S, etal. 2014 ESC/ESA
guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task
force on non-cardiac surgery: cardiovascular assessment and management of the European
Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J
Anaesthesiol. 2014;31(10):517–73.
2 Preoperative Testing intheEra ofCost Containment: Is There aLimit?
https://t.me/med1917
15. Wahlberg T, Blombäck M, Hall P, Axelsson G.Application of indicators, predictors and diagnostic indices in coagulation disorders. I.Evaluation of a self-administered questionnaire with
binary questions. Methods Inf Med. 1980;19(4):194–200.
16. Eika C, Havig O, Godal HC. The value of preoperative haemostatic screening. Scand J
Haematol. 1978;21(4):349–54.
17. Velanovich V.The value of routine preoperative laboratory testing in predicting postoperative
complications: a multivariate analysis. Surgery. 1991;109:236–43.
18. Narr BJ, Warner ME, Schroeder DR, Warner MA, editors. Outcomes of patients with no laboratory assessment before anesthesia and a surgical procedure. In: Mayo Clinic Proceedings.
Philadelphia: Elsevier, vol 124; 1997. p.428.
19. Thiruvenkatarajan V, Pruett A, Adhikary SD.Coagulation testing in the perioperative period.
Indian J Anaesth. 2014;58(5):565–72.
20. Chee YL, Crawford JC, Watson HG, Greaves M.Guidelines on the assessment of bleeding risk
prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J
Haematol. 2008;140(5):496–504.
21. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu
DC, etal. Management of severe perioperative bleeding: guidelines from the European Society
of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270–382.
22. Czoski-Murray C, Lloyd Jones M, McCabe C, Claxton K, Oluboyede Y, Roberts J, etal. What
is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function
tests before elective surgery in patients with no apparent clinical indication and in subgroups
of patients with common comorbidities: a systematic review of the clinical and cost-effective
literature. Health Technol Assess. 2012;16(50):i–xvi, 1–159.
23. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk
assessment for and strategies to reduce perioperative pulmonary complications for patients
undergoing noncardiothoracic surgery: a guideline from the American College of Physicians.
Ann Intern Med. 2006;144(8):575–80.
24. Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, etal. Risk factors
for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261–9.
25. Gong X, Poterack KA. Retrospective review of universal preoperative pregnancy testing:
results and perspectives. Anesth Analg. 2018;127(2):e4–5.
26. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF, American College of Surgeons
National Surgical Quality Improvement Program; American Geriatrics Society. Optimal
preoperative assessment of the geriatric surgical patient: a best practices guideline from the
American College of Surgeons National Surgical Quality Improvement Program and the
American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66.
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Preventing Never Events: Checklists,
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Timeouts, Debriefings, andSkin Marking
GeorgeMolina andAlexHaynes
Introduction
There were two seminal events in the late 1990s that laid the groundwork for subsequent quality and safety efforts in healthcare in the United States. In 1999, the
Institute of Medicine published a pioneering report titled, “To Err is Human:
Building a Safer Health System” [1]. The report estimated that about 98,000 deaths
were attributable to medical errors. This estimate was jarring and served as the necessary shock to the system that sparked numerous initiatives to make the delivery of
healthcare in the United States safer. These have been multi-pronged in their aims,
including improving the delivery of healthcare and promoting the reporting of medical errors. Since its publication, multiple concepts and tools in the healthcare quality and safety space have been developed including, but not limited to, never events,
timeouts, debriengs, skin marking, and checklists.
The second seminal event was the creation of the National Quality Forum (NQF).
In 1997, President Bill Clinton created the President’s Advisory Commission on
Consumer Protection and Quality in the Healthcare Industry. The purpose of the
panel was to “draft a bill of rights for healthcare consumers and to assess the need
for the federal government to regulate private health insurance plans” [2]. In 1999,
the commission made more than 50 recommendations, including the creation of a
nonpartisan organization that would be representative of all stakeholders in the
delivery, management, and utilization of healthcare and whose mission would be
“to promote and ensure patient protections and healthcare quality through measurement and public reporting” [3]. This led to the creation of the NQF, “the only
consensus- based healthcare organization in the nation as dened by the Ofce of
3
G. Molina
Brigham and Women’s Hospital, Boston, MA, USA
A. Haynes (*)
Department of Surgery and Perioperative Care, University of Texas Austin, Austin, TX, USA
e-mail: alex.haynes@austin.utexas.edu
© Springer Nature Switzerland AG 2024
J. J. Hoballah et al. (eds.), Principles of Perioperative Safety and Efciency,
https://doi.org/10.1007/978-3-031-41089-5_3
29
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Management and Budget” [4]. The NQF endorses reporting measures and evidencebased healthcare practices that are then adopted by the public and private healthcare
sectors.
G. Molina and A. Haynes
Never Events
The Institute of Medicine’s report and the founding of the NQF brought into focus
the need to improve the quality and safety of healthcare in the United States. “To Err
is Human” contextualized what we have always known in our daily lives—humans
make mistakes. This pioneering report made this commonly accepted human reality
a core tenet of quality and safety efforts in healthcare. This notion does not imply
that all mistakes lead to signicant patient harm. However, there are medical errors
that do lead to signicant patient morbidity and, at times, death. This led to the
concept of “never events,” which the NQF dened as medical errors or complications in healthcare that should never occur. With regard to surgery, never events can
be understood as complications that are not “acceptable risks of surgery” [5]. The
NQF has further developed the concept of never events and now refers to these
events as “serious reportable events.” There are currently 29 NQF-dened serious
reportable events, categorized into seven groups: (1) surgical or procedural events,
(2) product or device events, (3) patient protection events, (4) care management
events, (5) environmental events, (6) radiologic events, and (7) criminal events
(Table3.1).
Another important entity that has further expounded on the concept of never
events is the Joint Commission, which is an independent, not-for-prot organization
that evaluates and accredits healthcare organizations and programs throughout the
United States. The Joint Commission, which is the “nation’s oldest and largest
standards- setting and accrediting body in healthcare” [6], denes never events as
sentinel events in patient care that result in death, permanent harm, or severe temporary harm that requires life-sustaining interventions. In 1996, the Joint Commission
adopted a policy that encouraged accredited facilities to report sentinel events.
According to the Joint Commission, these events should be investigated with a root
cause analysis, and a response should be formulated by the accredited facility [7]. It
is important to note that the Joint Commission also considers the 29 events listed by
the NQF as sentinel events.
Many states have since adopted statewide reporting requirements for never
events or serious reportable events. The National Academy for State Health Policy
reported that as of 2015 there were 27 states and the District of Columbia that had
adverse-event reporting systems that were authorized and that had a documented
focus on adverse events with an intent to improve patient safety. Unfortunately, this
number of adverse-event reporting systems in the United States has remained static
since 2007 [8]. Although the number of adverse-event reporting systems has not
increased, these systems have embraced technological advancements and are facilitating the exchange and sharing of important information that is leading to improved
care by addressing areas in need of improvement (Fig.3.1).
3 Preventing Never Events: Checklists, Timeouts, Debriengs, andSkin Marking
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on a patient within or
on the grounds of a
healthcare setting
injury of a patient or
staff member
resulting from a
physical assault (i.e.,
battery) that occurs
within or on the
grounds of a
ordered by or
provided by someone
Criminal events
• Any instance of care
injury of a
patient or staff
• Death or serious
or serious disability
associated with an
• Patient or staff death
impersonating a
physician, nurse,
pharmacist, or other
licensed healthcare
provider
• Abduction of a
associated with
introduction of a
metallic object
into the MRI
area
electric shock in the
course of a patient
care process in a
healthcare setting
which a line
• Any incident in
patient/resident of
any age
• Sexual abuse/assault
designated for
oxygen or other gas
to be delivered to a
patient contains no
gas, the wrong gas,
• Death or signicant
or serious injury
associated with a
or is contaminated
by toxic substances
burn incurred from
• Patient or staff death
healthcare setting
any source in the
course of a patient
care process in a
healthcare setting
• Patient death or
serious injury
associated with the
31
use of restraints or
bedrails while being
cared for in a
healthcare setting
with a medication error (e.g., errors
• Patient death or serious injury associated
injury associated with the
Product or device events Care management events Environmental events Radiologic events
• Patient death or serious
procedure performed on
Surgical events
• Surgery or other invasive
Table 3.1 National quality forum list of serious reportable events, 2016
involving the wrong drug, wrong dose,
wrong patient, wrong time, wrong rate,
wrong preparation, or wrong route of
administration)
with unsafe administration of blood
products
associated with labor or delivery in a
low-risk pregnancy while being cared
• Patient death or serious injury associated
use of contaminated drugs,
devices, or biologics
provided by the healthcare
setting
injury associated with the
use or function of a device
• Patient death or serious
the wrong body part
procedure performed on
the wrong patient
invasive procedure
• Surgery or other invasive
performed on a patient
• Wrong surgical or other
for in a healthcare setting
• Maternal death or serious injury
in patient care, in which the
device is used for functions
other than as intended
• Patient death or serious
foreign object in a patient
after surgery or other
procedure
• Unintended retention of a
associated with labor or delivery in a
low-risk pregnancy
• Death or serious injury of a neonate
injury associated with
intravascular air embolism
that occurs while being
immediately
postoperative/
• Intraoperative or
with a fall while being cared for in a
healthcare setting
donor sperm or wrong egg
• Articial insemination with the wrong
• Patient death or serious injury associated
cared for in a healthcare
setting
post-procedure death in
an American Society of
Anesthesiologists Class I
pressure ulcers acquired after admission/
presentation to a healthcare facility
• Any stage 3, stage 4, or unstageable
patient
resulting from the irretrievable loss of
an irreplaceable biological specimen
from failure to follow up or
communicate laboratory, pathology, or
• Patient death or serious disability
radiology test results
• Patient death or serious injury resulting
Source: National Quality Forum. List of Serious Reportable Events. https://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx
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