BLSi (pronounced “bullseye”)

A project to prevent wrong-site surgery in dermatology.

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Background

• Wrong-site surgery is one of the most common adverse events (13.1%) reported by The Joint Commission [1].

• In a survey of dermatologists, wrong-site surgery accounted for 19% of the “most serious errors” [2].

• Biopsy-site photos eliminate errors in surgical site identification [3].

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Problem

• Two wrong-site procedures occurred in our department between 2016 and 2018.

• Neither case used a biopsy-site photo for site identification.

• Our baseline rate of high-quality biopsy-site photos was only 58%.

• Inadequate biopsy-site photography rates and low-quality photos are resulting in wrong-site procedures.

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Goal

To eliminate wrong-site surgery by improving biopsy-site photography quality and rates.

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Interventions

1. Development of high-quality photo criteria.

2. Education of physicians and staff. 

3. Visual aids/posters in clinical spaces.

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Results

We increased the rate of high-quality biopsy-site photos to over 80% and had Zero wrong-site surgeries since launching BLSi. 

Drs. Lohman and Klufas received the American Academy of Dermatology Resident QI Award for their work on BLSi.

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Resources

Our work is licensed under Creative Commons Attribution License. Please give credit to UCSF Dermatology QI team by linking to dermquality.org

• AAD presentation 

• Poster: How to take high-quality photos

• Poster: How to maximize landmarks in photographs

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References

1. Ke M, et.al. Where is it? The utility of biopsy-site photography. Dermatol Surg. 2010;36(2):198–202

2. Watson AJ, et.al.  Medical error in dermatology practice: development of a classification system to drive priority setting in patient safety efforts. J Am Acad Dermatol. 2013;68(5):729-737.

3. McGinness, et al. The value of preoperative biopsy-site photography for identifying cutaneous lesions. Dermatol Surg, 36 (2010), pp. 194-197.

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