The 5th anniversary of “Patient Safety in Surgery” – from the Journal’s origin to its future vision
© Stahel et al.; licensee BioMed Central Ltd. 2012
Received: 16 October 2012
Accepted: 16 October 2012
Published: 18 October 2012
Inception of a new journal
Journal of Poor Judgment in Surgical Decision-Making”
Journal of Surgical Errors and Preventable Complications”
Journal of Surgical Complications”
Journal of Preventable Complications and Patient Safety”
Ultimately, we decided to omit any negative aspect in the title, related to terms such as “errors” and “complications”, and instead to focus on an exclusively positive message in the final title, Patient Safety in Surgery. With strong support from the publisher, BioMedCentral (BMC), the new journal was successfully launched on November 7, 2007, accompanied by the first two peer-reviewed articles.
As outlined on the PSS homepage (http://www.pssjournal.com), the Journal’s mission is to increase the safety and quality of care for patients undergoing surgical procedures in all fields of surgery. The Journal was designed to complement the more than 200 traditional surgical journals by filling an essential void, through providing a forum for discussion, analysis, and work-up of system and process failures, technical complications, medical errors, and other adverse events in the management of surgical patients in the perioperative setting. This scientific forum was created to lower the threshold for reporting adverse events in all fields of surgery, with the long-term goal of increasing the safety and quality of care for patients undergoing surgical procedures. Ultimately, health care providers from around the world need to be able to safely and openly report anything that does not go well for their patients. As surgeons, we are the only group of people on earth whom other humans give formal consent to render them unconscious and open their bodies with a knife. Thus, we have the highest onus to leave no stone unturned in our quest to do the “right thing” for our patients. We strongly consider public reporting of medical errors and surgical complications an ethical responsibility of our profession. Therefore, we will continue to strive to offer PSS as a vehicle of transparency, trust, and credibility for the public who has a right to know the truth about the quality and safety of surgical care provided around the globe.
The first 5 years: a spectacular start
The top-25 most accessed articles have been viewed through the PSS website more than 500,000 times until present (http://www.pssjournal.com/mostviewed/alltime).
PSS has an “unofficial” impact factor of 1.19 (http://www.pssjournal.com). This impact factor is calculated by the identical formula as for the Journal Citation Reports (JCR®) and thus reflects a “real” number for the journal’s impact factor, albeit not (yet) officially sanctioned by Thomson Reuters .
Journal scope / Good prior experience
Journal reputation and profile
Fast peer review / Speed of publication
Overall, within just 5 years of the initial launch, PSS has been able to solidify its early reputation as an internationally respected journal in the important field of patient safety in the perioperative setting.
Challenges and road bumps
The design and implementation of PSS as a new journal in its field was accompanied by multiple challenges and hurdles. As an anecdotal example, many friends and colleagues (as well as the publisher’s legal advisers!) discouraged the founding editors from introducing an article category on “case reports”. The underlying argument was that “only a fool will agree to publish a case report on preventable complications which lead to poor patient outcomes”. This notion is based on the rationale that such a document would provide a written testimony (and admission of guilt) which could be used in court against the individual medical practitioner in case of a malpractice claim or lawsuit. The ultimate resolution consisted of introducing a mandatory request for submitting authors to provide a written consent from patients or their legal guardians for any manuscript which provides information on specific identifiable individual patient scenarios (http://www.pssjournal.com/authors/instructions).
Strikingly, we were astonished by the unexpected high submission rate of case reports on surgical complications, preventable sentinel events, and “never events”, starting from the first weeks of the journal’s launch [6, 7], until the present day [8, 9]. This impressive fact supports the notion that health care providers all over the globe appear to strive to publicly report, analyze, and discuss root causes and preventive measures of adverse events which lead to unnecessary patient harm, in order to provide more transparency to other health care providers, and to the public. Indeed, until present, PSS published a total of 50 case reports on individual complications and medical errors, and the manuscript submissions in the “case report” category keep coming in.
Beyond a doubt, the main barrier which deters authors from submitting their work to PSS (and for that matter to open access journals in general) is represented by the extremely high publication fees. For journals published by BMC, these so-called “article processing charges” (APCs) – which have to be carried by the author – range from $1,600 to $1,900 per article (http://www.biomedcentral.com/about/apcfaq). A recent commentary published in Science discussed the findings of a large-scale survey on the perceived role of open access online journals among 50,000 researchers . While 89% of all respondents expressed their support for open access publishing in general, they admitted to publish only about 10% of their own research in open access journals . The two main reasons stated for the poor submission rate were high publication fees (40%) and the apparent lack of high-quality open access journals in the respondents’ field of interest (30%) .
And here lies the conundrum of open access publishing: Why would a hypothetical author submit high-quality research to an open access journal with low reputation and no (or low) impact factor, which comes at a price of up to $2,000 publication costs, instead of targeting a prestigious high-impact print journal, free of charge? The answer is intuitive.
Incentives to publish in PSS
PSS has seen a tremendous start in its first 5 years, and we have successfully resolved some of the initial “childhood diseases” of any new journal. In order to overcome the financial impediment for submission of high-quality articles imposed by the high processing fees, we were recently able to obtain independent grant support for coverage of the APC fees for 30 articles submitted by outside researchers. Pre-submission inquiries for qualification of a waiver for processing fees should be submitted to the editorial board (email@example.com). Requests will be screened by the managing editors based on objective metrics related to the manuscript’s scientific quality. An anecdotal example of a manuscript which was actively commissioned for PSS, with the authors’ APC fees being waived through extramural grant support, shows that this paper is currently ranked as the #1 most viewed article in the Journal of all times, with more than 23,000 accesses until present . This example supports the argument that high-quality submissions are difficult to commission in presence of the financial “APC barrier”.
Undoubtedly, the open access modality of publishing in PSS provides unprecedented advantages compared to standard print journals. The elimination of financial barriers related to individual or institutional journal subscriptions allows for global and unrestricted free access to all published articles. This proactive modality likely represents the underlying reason for a new journal, such as PSS, being read in more than 180 countries around the world (Figure 2). In addition, submitting authors from developing countries can request a formal APC waiver by the publisher, which is usually granted within a few days of the inquiry.
All articles published in PSS are free to read, copy, distribute, and re-publish in parts or in entirety (with attribution of the original source).
Authors retain the full unrestricted copyright on the entire article. This allows for replicating data and figures in future publications (e.g. review articles or book chapters) without the need for requesting a formal copyright release by the publisher, as long as the original source is adequately cited.
There is no limit to the length of an individual article, including the number of tables and figures.
There are no extra charges for publishing an unrestricted amount of high-quality color figures.
Movie clips can be embedded for instructional purposes at no extra cost, through embedded links in the manuscript (see example: ).
The fast-track publication process allows for short turn-around times of submitted manuscripts and publication within about 2 months of initial submission. All articles are cited in PubMed within less than one week of provisional publication.
All articles published in PSS are archived in public repositories, including PubMed Central, in compliance with the NIH Public Access Policy.
The next 5-year vision
Journal of Hematology & Oncology (2008; IF 3.99)
PLoS ONE (2006; IF 4.09)
Molecular Neurodegeneration (2006; IF 4.28)
Journal of Neuroinflammation (2004; IF 3.83)
Retrovirology (2004; IF 6.47)
BMC Biology (2003; IF 5.75)
PLoS Biology (2003; IF 11.45)
Genome Biology (2000; IF 9.04)
Breast Cancer Research (1999; IF 5.25)
These selected open access journals serve as pioneer role models with regard to the gradual transition from the “classic” entity of print publication to the future model of open access publishing of high quality science in high impact online journals. Clearly, the impact factor alone does not guarantee the quality of submitted papers, but rather represents a surrogate marker for the scientific renown of a journal in the international community. However, in this day and age of restricted grant funding opportunities, a journal with a (high) impact factor is more likely to be targeted by better quality submissions.
Another important and challenging goal for the next 5 years includes the plan to inaugurate an “International Society for Patient Safety in Surgery”. This new society will further enhance the current global patient safety initiative aimed at increasing transparency about the quality of medical care to the public, who remains the ultimate stakeholder . The obligation for us, as physicians and surgeons, lies in sustaining our public credibility by full and honest disclosure and reporting of medical errors and surgical complications .
Ultimately, PSS strives to position itself as a landmark journal in the field of patient safety in the perioperative setting, with a global renown for publishing high-quality science in this important field. There is a lot of work ahead of us. We would like to thank our readership, submitting authors, peer reviewers, and our editorial board for their loyalty in the past 5 years, and for their continuing support of the journal’s mission in the future.
The authors are indebted to Nicole Zindel (http://www.zindelwerbung.ch) for the design of the “PSS logo” on the Journal’s homepage. The Colorado Physician Insurance Company (COPIC) is gratefully acknowledged for providing independent grant support to cover the processing fees of selected articles submitted to PSS. We would like to furthermore thank Drs. Ted Clarke and Mike Victoroff for their ongoing support and continuing fruitful discussions on the important topic of perioperative patient safety. Last but not least, we are indebted to the Journal’s publishing staff at BMC, particularly Ms. Shivani Patel and Mr. Brian O’Connor, for their professional operational support for sustaining the Journal’s mission.
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