Site Verification: The JCAHO Verdict

Cardiac catherization procedures are not exempt from the site marking requirement. The primary reason for site marking in these cases is to avoid doing the procedure on the wrong patient. We have such cases in our database. Even when there is a likelihood that the precise entry point for a procedure might not be determined until the time of the procedure itself, there is usually an expectation for a general area or starting point. This is the site that should be marked. The marking should be done before the patient is brought to the cath lab. If in the course of the procedure,the incision site is changed because of the clinical findings, then of course the case must proceed. We are currently working out the language to allow an exemption from the site marking requirement for situations in which the practitioner performing the procedure is in continuous attendance with the patient from the time of the discussion of the procedure with the patient and obtaining of informed consent from the patient through to the actual performance of the procedure. Other than that "continuous attendance" scenario, the Goal does require site marking for all procedures, including cardiac catheterizations and interventional imaging procedures, except for procedures done through or immediately adjacent to a natural body orifice (e.g., GI endoscopy). We recognize that there are multiple possible access sites and that the one that is actually used may not be known prior to the procedure itself. It is not expected that all possible access sites will be marked, but at least the usual site that is initially considered for the procedure should be marked. The purpose here is to provide a redundant process (complementary to the pre-op verification process and the "time-out" just before starting the procedure) to avoid a wrong patient procedure. Unfortunately, there are several documented cases of wrong patient cardiac catheterization procedures. Our data show that no single approach, such as time-out, will reliably eliminate the risk of this type of error, thus the requirement for redundant safeguards. Richard J. Croteau, MD, Executive Director for Strategic Initiatives, Joint Commission on Accreditation of Healthcare Organizations

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