Resources

Peer-Reviewed Publications

  1. Cafazzo JA, St-Cyr O. From discovery to design: the evolution of human factors in healthcare. Healthc Q. 2012;15 Spec No:24-29.
  2. Canale ST. Wrong-site surgery: a preventable complication. Clin Orthop Relat Res. 2005;433:26–29. 
  3. Clarke JR, Johnston J, Finley E. Getting surgery right. Ann Surg. 2007;246(3):395-405. 
  4. Devine J, Chutkan N, Norvell DC, Dettori JR. Avoiding wrong site surgery: a systematic review. Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S28-36.) 
  5. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000. 8, Creating Safety Systems in Health Care Organizations.
  6. James MA, Seiler JG, 3rd, Harrast JJ, Emery SE, Hurwitz S. The occurrence of wrong-site surgery self-reported by candidates for certification by the American Board of Orthopaedic Surgery. J Bone Joint Surg Am. 2012;94(1):e2(1-12). 
  7. Seiden SC, Barach P. Wrong-side/wrong-site, wrong- procedure and wrong-patient adverse events: are they preventable? Arch Surg. 2006;141(9):931-939. 

Wrong-Site Surgery in the News

  1. Associated Press. Millions awarded to man for surgery on wrong side of brain. CBS News, November 19, 2015. 
  2. CBS News Interactive. Mix-up leads to surgical procedure on wrong baby. CBS News, February 5, 2016. 
  3. Harshman, M. Eye surgeon’s error confounds boy’s parents. The Columbian, April 20, 2011.
  4. Kowalczyk, L. Beth Israel erred in 3 spinal operations -- Vertebrae mix-ups spur new procedures. Boston Globe, December 24, 2010. 
  5. Lerner, M. Wrong kidney removed from Methodist Hospital cancer patient. Star Tribune, March 18, 2008.
  6. Wang, AB. He underwent surgery to remove his right testicle. When he woke up, his left one was missing. Washington Post, June 18, 2017. 

Other Resources

  1. Agency for Healthcare Research and Quality. Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. Accessed 3/13/2018.
  2. Agency for Healthcare Research and Quality. Systems Approach. Accessed 12/6/2017.
  3. AORN. National TIme Out Day. Accessed 3/13/2018.
  4. Chassin, M. and Groah, L. Letter to Perioperative Nurses re: National Time Out Day. Accessed 3/13/2018
  5. ISMP. Medication Error Prevention “Toolbox.” 1999. Accessed 12/4/2017.
  6. Jack's Daily Dose. Sign your Site Campaign. Accessed 3/13/2018.
  7. The Joint Commission. Sentinel Event Data Summary, February 23, 2018. Accessed 3/13/2018.
  8. World Health Organization. Safe Surgery: Why Safe Surgery is Important. Accessed 3/13/2018.

Latest Updates

Clinical Experience With StartBox: A Multi Center Review of 487 Cases

An evaluation of 487 orthopedic surgery procedures with the StartBox System identified 17 near miss events that could have led to the occurrence of a wrong-site surgery. The use of the System resulted in the occurrence of zero wrong site surgeries.
Read More.

Go to Zero 

Start using the StartBox System in your clinic, surgery center or hospital operating room to eliminate wrong site surgery today.

Contact Us

Error Message