Not to be a wet blanket, but much of this issue highlights some of the many things that can go wrong in outpatient surgery.

• ASCs are an ambulance ride away from the hospital. On page 12, we report on the risk factors that are proven to increase the chances of hospitalization immediately after outpatient surgery - including being 65 or older, receiving general anesthesia and being in surgery for longer than two hours, according to a study in the March Archives of Surgery that included more than 783,500 procedures at hospital-based and freestanding ambulatory surgery centers in New York during 1997. The message to consumers is one that some of you might not want to hear: Older patients and those with more health problems or more complicated procedures may want to think twice about using a standalone facility, even if it's more convenient than a hospital.
• Scars from nurse-to-nurse hostility run deep. On page 13, we present new research findings on the effects of violence in the healthcare workplace. Not only does the research find a connection between post-traumatic stress disorder and workplace violence, but it also suggests that patient safety is compromised in facilities with higher levels of lateral violence.
• Surgery is a likely place for a medication error to occur. Our cover story on page 34 highlights a landmark study that looked at more than 11,000 medication errors between 1998 and 2005. The study found that surgery patients are three times more likely to experience a harmful medication error than patients anywhere else in the healthcare system. The study pointed a finger at the surgical department's disjointed nature. What is generally called "surgery" is actually a system of several different departments that patients must be transported through to receive perioperative care and each department is likely to have different teams of healthcare providers, say researchers.

"Even if located along a single hallway, these departments can be remarkably disconnected from one another," says one of the authors of the report. "The fragmented system creates a high risk for harmful medication errors."

• Surgical fires can happen. On page 73, a surgeon whose patient's face caught fire during a cosmetic procedure shares with you his thoughts on how the fire happened. If nothing else, his forthcoming account serves as a reminder that a fire is simply a spark away whenever the elements for a surgical fire are present: an ignition source, an oxidizer and a fuel. In this case, electrosurgery, oxygen and drapes made up the fire triangle.

In the name of improving patient safety, we hope you find this issue helpful.