Risk Management

Message from the Chairman (discussed frequency and types of errors)

Wrong site/wrong IOL surgery

errors continue to plague our profession despite a concerted effort by OMiC to educate insureds and others about the circumstances that lead to such errors and provide risk management recom- mendations to help prevent them.

A recent retrospective study of 42 OMiC claims and 64 new York state cases by John W. simon, MD, et al, published in Archives of Ophthalmology (vol. 125, no.11) addressed the effectiveness of the universal Protocol as a prevention tool. According to the study, even if the protocol were perfectly implemented, 15% of errors would remain. Recent events in Florida, where ophthalmologists have incurred substantial fines and penalties imposed by the state medical board, and the persistence of wrong site/wrong iOL errors has galvanized OMiC and its sponsor, the American Academy of Ophthalmology, to examine what can be done to eliminate these errors.

First, the problem must be put in perspective. Wrong site and wrong iOL errors are very low in frequency, indicating that proper safeguard systems are currently in place and working fairly well. in our 21 years of existence, approximately 4,679 lawsuits, claims, and incidents have been reported to OMiC. Only about 220, or 5%, have been related to “wrong” events. since 1997, the percentage of insureds who have reported a wrong site or wrong iOL matter to OMiC has stayed relatively constant at a median annual average of about 0.5%.

however infrequent, these types of errors have drawn the attention of the public and state and federal policymakers, resulting in fines and licensing sanctions against physicians and non-payment of services by Medicare and other payors. the AAO, OMiC, and other ophthalmic societies are taking a two-prong approach to the problem—education and prevention—via the Academy Practice improvement task Force and a three-year Academy Campaign to eliminate Wrong site/Wrong iOL surgery.

the first charge of the Practice improvement task Force, a group of seven ophthalmologists representing the AAO, ABO, AuPO, and OMiC, is to develop an online CMe activity that will allow ophthalmologists to compare their own practice to those that follow evidence-based performance measures and protocols proven to reduce errors. simple-to-use checklists will help participants adopt the protocols in their own office. Anonymous data collection of pre- and post- education practice activities will enable the task force to evaluate the effectiveness of the practice improvement activity on care outcomes.

the campaign to eradicate “Wrong site surgery and Wrong iOL implantation” in the u.s. within three years is another cooperative group effort of ophthalmologists and is led by Gary s. schwartz, MD. the group will review suggestions drawn from evidence-based medicine to help surgical teams evaluate and improve their own safety systems to eliminate all sources of wrong site or wrong iOL errors, whether operating in an office, hospital, or ambulatory surgery center.

At the state level, the Florida society of Ophthalmology is working with OMiC and the Academy to educate FsO members on wrong site/ wrong iOL surgery prevention. Florida is “ground zero” when it comes to the regulatory impact of system errors, and ophthalmologists in particular have borne the brunt of fines and licensure sanctions. the reason lies principally with the reporting requirements of AsCs and hospitals to the Florida medical board when a wrong site or wrong iOL error occurs in the operating room. the FsO is partnering with the Florida Board of Medicine to develop a statewide regulatory/ disciplinary process to handle and correct the systems that produce such violations.

With the leadership and participation of so many prominent ophthalmic organizations, we hope to make the persistent problem of wrong site/wrong iOL a “never” event.

Joe R. McFarlane Jr., MD, JD OMIC Chairman of the Board