To make sure doctors didn't operate on the wrong side of a patient, they asked the teenage patient to write "yes" on the leg that needed surgery.

He got bored. He had a marker. The surgeon came back to find doodles all over both legs.

The old Intermountain Healthcare might have trusted the surgeon to know which leg needed surgery. However, new policies in the last several years ask both doctor and patient to identify the limb that's going to get cut open to make sure the correct one is operated on.

"What we had to do was get out a lot of alcohol and erase everything from both legs and start over," said Fritz Kron, regional quality director at Utah Valley Regional Medical Center.

Wrong-side surgery, lost sponges and surgical equipment and someone posing as a health care provider are some of the sentinel, or patient safety, events from hospitals and ambulatory surgery centers that the Utah Department of Health is now reporting and examining. The 2008 numbers report a 56 percent increase in sentinel events from 2007 to 2008, which has more to do with more and better reporting than more mistakes, said Iona Thraen, the patient safety director for the Utah Department of Health.

Of the 89 reported sentinel events, 28 ended in the death of the patient, and another six caused major permanent harm. Leaving an object inside a patient during surgery happened 28 times, and the wrong body part was operated on eight times. Once someone pretended to be a health care provider.

The sentinel events are largely caused by miscommunication or human error. Every hospital has systems in place, but they don't work perfectly, Thraen said.

"There's a whole set of strategies that can be used, and to do those at the same time as providing health care often can be a challenge," she said.

Numbers were not released by hospital or by county because the purpose of the reports are to address issues that need to be fixed, not to blame any person or group.

"It's not that health care is unsafe or that people should be very worried about going to a hospital," Kron said, although he acknowledged that all procedures carry a certain amount of risk.

Reports and analyses from the last several years from hospitals throughout Utah and the United States led to standardized methods for procedures, such as writing "yes" on the operable body part. Using bar codes on medication also has helped to ensure patients get the right pills, even though scanners now are a part of every room.

"We will always need to go further," Kron said. "Health care is a dynamic, changing industry, and for every new advance that comes out that allows us to do things that we haven't been able to do before, to accomplish things that haven't been done before, there are always going to be unintended consequences."

Marilyn Mariani, the chief nursing officer for Lakeview Hospital in Bountiful and the chairwoman for the sentinel event user group, which comprises industry professionals who asked for more stringent reporting, said medication mistakes have been a problem in the past, largely because of a lack of communication between doctors, nurses and patients. They have worked to make that clear as well as putting bar codes on all medication and on patient armbands, which helps to ensure the right patient gets the right medication.

Color-coded arm bands, new technologies and increased patient involvement all are part of the health care industry's move toward fewer mistakes.

"Our overall goal is to get the information, understand the trends and figure out what do we need to do to improve things," Mariani said, adding they have learned to not rely on memory or tradition. "You've got to find things that hard-wire human behaviors."

• Heidi Toth can be reached at (801) 344-2556 or htoth@heraldextra.com.