title: Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety.
abstract: BACKGROUND
  The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited.
  
  
  OBJECTIVE
  We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems.
  
  
  METHODS
  We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles.
  
  
  RESULTS
  Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care.
  
  
  CONCLUSIONS
  Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.
authors.affiliation: San Francisco Orthopaedic Residency Program, St Mary's Medical Center, San Francisco, CA, USA.
authors.forename: Calvin C
authors.initials: CC
authors.lastname: Kuo
authors.forename: William J
authors.initials: WJ
authors.lastname: Robb
mesh_terms: D003142:Communication; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D007857:Leadership; D015279:Organizational Culture; D009985:Orthopedics / Q000379:methods / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety / Q000592:standards*; D016730:Program Development