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Updated: Apr 28, 2026

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
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Wrong-side thoracentesis: lessons learned from root cause analysis.

Kristen E Miller1, Maisha Mims1, Douglas E Paull1

  • 1Department of Veterans Affairs National Center for Patient Safety, Ann Arbor, Michigan.

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|June 13, 2014
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Summary
This summary is machine-generated.

Wrong-side thoracentesis, a serious patient safety event, often results from failures in Universal Protocol adherence, including time-outs and site marking. Improving teamwork and training is crucial for prevention.

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Area of Science:

  • Patient Safety
  • Medical Error Analysis
  • Thoracic Surgery

Background:

  • Incorrect surgical procedures, including wrong-site thoracentesis, remain a significant cause of sentinel events despite established safety protocols.
  • These errors can lead to severe patient harm and fatal consequences, highlighting a critical gap in patient safety measures outside the operating room.

Purpose of the Study:

  • To investigate the contributing factors of wrong-side thoracenteses by analyzing a root cause analysis database.
  • To identify specific breakdowns in safety protocols and team dynamics associated with these adverse events.

Main Methods:

  • A retrospective analysis of the National Center for Patient Safety database was conducted.
  • Cases of wrong-side thoracentesis performed in ambulatory clinics and hospital units (excluding operating rooms) between January 1, 2004, and December 31, 2011, were examined.

Main Results:

  • Fourteen cases of wrong-side thoracentesis were identified, with common contributing factors including failure to perform time-outs (n=12), missing laterality on consent forms (n=10), lack of skin site marks (n=12), and unverified medical images (n=7).
  • Complications included pneumothoraces (n=4), hemorrhage (n=3), and two deaths directly attributed to the procedure.
  • Root causes frequently involved teamwork and communication failures, policy non-adherence, and deficits in training and education.

Conclusions:

  • Preventing wrong-site procedures outside the operating room necessitates strict adherence to the Universal Protocol, including time-outs and proper site marking.
  • Effective teamwork, comprehensive training, mentorship, and vigilant patient assessment are vital for error detection and complication management.
  • Time-outs serve as critical protected periods for identifying and correcting potential errors, underscoring their importance in patient safety.