Decreasing the occurrence of intraoperative technical errors through periodic simple show, tell and learn method.
BACKGROUND
Technical errors (TE) that occur during surgery for treating fractures are considered as being preventable by good preoperative planning and surgeon education. This prospective study evaluated a new instructional method for improving surgical outcomes that involved assessing surgeons' own recent performances.


METHODS
Postoperative radiographs from two groups of patients were assessed during consecutive 4-month periods. 350 operations were included in the Early Group and 411 operations in the Late Group. All the TE that occurred during the first period were reviewed and discussed among the residents and the consultant surgeons who had performed those operations. The same procedure was followed 4 months later. The TE were classified as minor, moderate and major.


RESULTS
The two groups included the same 41 surgeons. The most common TE were: insufficient reduction, varus and valgus malalignment and prominent hardware. The total number of errors dropped significantly, from 52 (14.7%) during the first period to 26 (6.3%) during the second period (p = 0.0003). The TE score severity dropped from 81 to 38, respectively (p = 0.0001). The most affected regions were, the humerus (p < 000.1), midshaft femur (p = 0.007), proximal femur (p = 0.004) and radius (p = 0.008). Most of the gains were made in the moderate category (p = 0.0001). The consultants performed statistically better than the residents in the first period (12% vs. 20%, p = 0.036), but almost similar to the residents in the second period (5.3% vs. 9%, p = 0.164). A TE index was calculated by dividing the accumulated sum by the number of operations and it dropped in both groups from 0.2 and 0.3 to 0.09 and 0.09, respectively.


CONCLUSIONS
Intraoperative TE can be significantly reduced by periodic performance evaluations in a seminar setting during which groups of surgeons can review the TE that they and their colleagues had made during recent orthopaedic surgical procedures.


METHODS
Level II.
Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: steinberge@tlvmc.gov.il.
Ely L
EL
Steinberg
Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eyal
E
Amar
Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Assaf
A
Albagli
Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Ehud
E
Rath
Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Moshe
M
Salai
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005592:Fracture Fixation / Q000592:standards*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008875:Middle Aged; D011300:Preoperative Care / Q000592:standards; D011446:Prospective Studies; D012307:Risk Factors
Fracture treatment; Intraoperative technical errors; Surgeon education