The Orthopaedic Forum   |    
Patient Safety in North America: Beyond “Operate Through Your Initials” and “Sign Your Site”*
David A. Wong, MD, MSc, FRCS(C)1; Brendan Lewis, MD, FRCS(C)2; James Herndon, MD, MBA3; Claude MartinJr., MD, FRCS(C), CSPQ, MBA4; Robert Brooks, MD, PhD, MBA5
1 Denver Spine, Suite 100, 7800 East Orchard Road, Greenwood Village, CO 80111. E-mail address: ddaw@denverspine.com
2 CIBC Building, 3rd Floor, Suite 301, Box 814, Station Main, Cornerbrook, NL A2H 6H6, Canada. E-mail address: blewis@thezone.net
3 Massachusetts General Hospital, 55 Fruit Street, White 542, Boston, MA 02114. E-mail address: jherndon@partners.org
4 The Canadian Medical Protective Association (CMPA), 875 Carling Avenue, P.O. Box 8225, Stn T, Ottawa, ON K1G 3H7, Canada. E-mail address: cmartin@cmpa.org
5 Delmarva Foundation for Medical Care, 6940 Columbia Gateway Drive, Columbia, MD 21046-2788. E-mail address: bobbrooksster@gmail.com
View Disclosures and Other Information
This symposium was presented at the Combined Meeting of the American Orthopaedic Association and the Canadian Orthopaedic Association in Quebec City, Quebec, Canada, on June 6, 2008.
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jun 01;91(6):1534-1541. doi: 10.2106/JBJS.H.01462
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Orthopaedic surgeons in Canada and the United States have been leaders in the patient safety movement1-8. Early efforts addressed wrong-site surgery. Both the "Operate Through Your Initials" program9, introduced in 1993 by the Canadian Orthopaedic Association (COA), and the "Sign Your Site" initiative10,11, introduced in 1998 by the American Academy of Orthopaedic Surgeons (AAOS), predate the 2000 publication of To Err is Human: Building a Safer Health System by the Institute of Medicine12. That report estimated that between 44,000 and 98,000 patient deaths from medical errors occurred in the United States each year. Following that report and the associated media attention, there has been more widespread interest in patient safety and medical errors.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Have you heard? The saga of wrong site surgery continues. Plast Surg Nurs 2008 Jan-Mar;28(1):41-4.
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Connecticut - Orthopaedic Foundation
    DC - Children's National Medical Center