Patient safety in spinal surgery: from scene of injury to discharge

In 1999 the Institute of Medicine (IOM) report “To Err is Human. Building a Safer Health System”, was a landmark publication that identified adverse events associated with surgery. The IOM report was effectively a wakeup call for a safer healthcare system for patients. Fourteen years later, much has been achieved, but patient safety still remains an important issue.The IOM report categorized incidents as nonsurgical and surgical, although nothing was specifically directed at spinal surgery. Some of the broad topics of concern that may relate to the spine were medication errors, infection, and technical problems of surgery. Almost 50% of adverse events identified in the IOM report were surgical in origin. Technical errors constituted the most frequent adverse events within surgery- however, the IOM did not specify what these were. According to other studies, we can deduce some of the most frequent technical issues in spine surgery; these include: wrong-level surgery, incomplete decompression, dural tears, battered root syndrome, and development of instability.We review the spinal patient pathway of the trauma patient, including pre-hospital and peri-operative care, and focus on strategies and campaigns to improve patient safety such as the WHO surgical safety checklist.