To identify the barriers to implementation and the strategies for successful implementation, the Pennsylvania Patient Safety Authority's 21 potential recommendations to prevent wrong-site surgery were sent to the 417 Pennsylvania facilities with operating rooms. The survey divided the 21 recommendations into five groups, with a total of six goals and eight potential measurement standards for the groups. For each of the six goals, respondents for the facilities were asked to describe barriers to implementation of the recommendations that would prevent the facilities from meeting the standard(s) for the goal. They were asked to describe any strategies for successful implementation. And, they were asked to comment on the feasibility and potential cost impact of implementing the recommendations associated with the standard(s). Responses were received from 70 facilities, for a response rate of 17%. Two-thirds of the responses were from hospitals, and one-third were from ambulatory surgical facilities. Physician behavior was cited most commonly as a barrier to implementation, followed by difficulty accessing accurate information prior to the patient's arrival in the preoperative holding area. Strategies for successful implementation of the recommendations included education, audits, leadership, and empowerment of nurses to "stop the line." All of the recommendations were considered feasible. The recommendation that intraoperative imaging studies of the spine be verified by a second qualified physician was considered costly and was modified accordingly.
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