In 2018, a major academic hospital was placed in a state of urgency when they were reported for four cases of patient misidentification, each of which resulted in erroneous and inappropriate medical care[1]. In more than one case, patients received imaging and/or diagnostic tests that were ordered for another patient — procedures that carried moderate risk, but were analysed as relatively neutral. However, in a shocking case, a patient underwent surgery on the wrong anatomical body part. Rhode Island Hospital has made significant investments to ensure that such medical errors will not occur again. However, the errors in patient identification demonstrate that the issue is still prevalent in the U.S. healthcare setting, even in reputable hospital systems. Specific to anesthesiology and surgery, addressing patient misidentification is critical for efficacious and ethical patient care.
Patient identification is broadly defined as the secure confirmation that an individual is the person whom they claim to be, and once that has been verified, that the patient is receiving the services that are intended for him or her. If both conditions are not met in the healthcare setting, then it is considered patient misidentification and could thereby result in legal and medical consequences for the health system. As per the World Health Organization, the healthcare sub-specialties in which patient misidentification is more likely to occur are drug administration, phlebotomy, blood transfusions, and surgical interventions[2]. Anesthesia is involves drug administration and the perioperative period, rendering patient misidentification as an issue critical to the field.
Henceforth, how can anesthesia providers and OR staff ensure correct patient identification? At the policy level, there are many options for the provider and the practice to implement. At the practice management level, standards of practice should be communicated to all providers, from anesthesiologists to Certified Registered Nurse Anesthetists (CRNAs) to operating room nurses. Such a policy could include, for example, multiple corroborating patient identifiers as identity proof (e.g. a portion of the SSN and current address in addition to full name), physical markers with the identity of the patient staying on the patient at all time during the stay (e.g., wristbands), multiple verbal verifications (asked in an open-ended fashion), or dedicated time during the procedure to verify patient identity and site of surgery[3]. Additionally, policies must be enforced by anesthesia and operating room leaders, whether physicians or nursing staff. To ensure consistency, it must be a strategic priority of the administrator or chairperson to enforce standards of practice as they concern patient identification, whether that means provisioning for a staff member or clinician that is responsible for the task of patient identification, or providing in-service training to all practitioners to ensure education is up to date.
With regards to technological advancements, several sophisticated options for patient identification are entering the scope of possibility. Multiple companies have produced advanced biometric identification technologies, such as identifying individuals by palm-vein technology, thumb scans, two-step verification, or facial analysis applications[1]. While novel technologies may be expensive at first, they will likely prove to be the next generation method of securely verifying a patient’s identification once integrated into the system’s electronic medical record (EMR).
At every hospital and healthcare system, confirmed patient identification is crucial for delivering patient care, particularly in the field of anesthesiology. By bolstering standards of practice and utilizing novel biometric technologies, anesthesia practice managers as well as anesthesia providers themselves, can continue the mission to deliver high-quality, appropriate care to all.
[1] Miller, G. Wayne. “R.I. Hospital Enters Consent Agreement after 4 Patient Errors in 4 Weeks.” Providence Journal, Providencejournal.com, 9 June 2018, www.providencejournal.com/news/20180608/ri-hospital-enters-consent-agreement-after-4-patient-errors-in-4-weeks.
[2] World Health Organization, et al. “Patient Safety Solutions.” World Health Organization, 2007, www.who.int/patientsafety/solutions/patientsafety/PS-Solution2.pdf.
[3] AST Education and Professional Standards Committee. “Standards of Practice for Patient Identification, Correct Surgery Site and Correct Surgical Procedure.” Association of Surgical Technologists, Oct. 2006, www.ast.org.
[4] Wood, Megan. “How Biometric Identification Enhances Patient Safety and the Hospital’s Bottom Line.” Becker’s Hospital Review, Dec. 2017, www.beckershospitalreview.com/cybersecurity/how-biometric-identification-enhances-patient-safety-and-the-hospital-s-bottom-line.html.