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Catherine Y. Lau, S. Ryan Greysen, Rita I. Mistry, Seunggu J. Han, Praveen V. Mummaneni and Mitchel S. Berger

the checklist. Although no wrong-site or wrong-side surgeries were reported in their study, a recent national survey of neurosurgeons reveals an otherwise troubling trend. Twenty-five percent of surveyed neurosurgeons reported making an incision on the wrong side of the head, and 35% reported wrong-level lumbar surgical procedures during their career. 11 In addition, the operative checklist that was implemented in the Mayo Clinic study did not address any concerns specific to neurological surgery and did not explicitly encourage open communication practices among

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Judith M. Wong, Jaykar R. Panchmatia, John E. Ziewacz, Angela M. Bader, Ian F. Dunn, Edward R. Laws and Atul A. Gawande

in the United States, 1996–2000 mortality, morbidity, and the effects of hospital and surgeon volume . J Clin Endocrinol Metab 88 : 4709 – 4719 , 2003 9 Bernstein M : Wrong-side surgery: systems for prevention . Can J Surg 46 : 144 – 146 , 2003 10 Birkmeyer JD , Finlayson EV , Birkmeyer CM : Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative . Surgery 130 : 415 – 422 , 2001 11 Birkmeyer JD , Siewers AE , Finlayson EV , Stukel TA , Lucas FL , Batista I , : Hospital volume

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Changing our culture to advance patient safety

The 2013 AANS Presidential Address

Mitchel S. Berger, Robert M. Wachter, S. Ryan Greysen and Catherine Y. Lau

codes for these “never events,” recorded only 9 such events over a 3-year period. The ABNS Credentials Committee identified 41 wrong-site or wrong-side surgeries in a 10-year period. The Joint Commission reported nearly 900 wrong-patient/wrong-site/wrong-procedure events throughout surgery in general over an 8-year period. If we break out just neurosurgery, there were 27 “never events” in this 8-year period. So this averages out to be about 2–4 events per year. But there was an article that came out of a Canadian survey in which 25% of polled neurosurgeons reported

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Adetunji A. Oremakinde and Mark Bernstein

, : The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada . CMAJ 170 : 1678 – 1686 , 2004 3 Bates DW , Cullen DJ , Laird N , Petersen LA , Small SD , Servi D , : Incidence of adverse drug events and potential adverse drug events. Implications for prevention . JAMA 274 : 29 – 34 , 1995 4 Bernstein M : Wrong-side surgery: systems for prevention . Can J Surg 46 : 144 – 146 , 2003 5 Bernstein M , Brown B : Doctors' duty to disclose error: a deontological or Kantian ethical analysis

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Jian Guan, Andrea A. Brock, Michael Karsy, William T. Couldwell, Meic H. Schmidt, John R. W. Kestle, Randy L. Jensen, Andrew T. Dailey and Richard H. Schmidt

included a large number of events that were unrelated to the practice of overlapping surgery. It is our hope, however, that by doing so we avoided missing significant adverse events. Although certain events such as wrong-site or wrong-side surgery may be more easily attributable to the distraction that can result from running multiple overlapping cases, the incidence of these complications is fortunately very low. Indeed, within our cohort, no wrong-site or wrong-side surgical errors occurred during the study period. The rarity of these complications makes studying them