RT Journal
A1 Herndon, James H.
T1 The Patient First. Above All Do No Harm (Primum Non Nocere)
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2013
FD February 20
VO 95
IS 4
SP 289
OP 290
DO 10.2106/JBJS.9504edit
UL http://dx.doi.org/10.2106/JBJS.9504edit
AB 
To date, altruism and professionalism haven’t worked, pay-for-performance programs haven’t worked, and regulations haven’t worked2. Estimates of avoidable injuries and deaths remain unchanged or are increasing, and readmissions remain unchanged at 15% to 24%3. Hospitals only voluntarily report errors, and these reports yield an error rate of about 1%. However, using a global trigger tool, the Institute of Healthcare Improvement estimates that the rate of adverse events is ten times the voluntarily reported rate4. Except in hospitals that strictly enforce a preoperative time-out and require the surgeon to sign the correct surgical site, the incidence of wrong-site surgery is increasing5. Why do we keep doing the same things over and over again and expect a different result?