Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery

Lepänluoma, M.; Takala, Riikka; Kotkansalo, Anna; Rahi, Melissa; Ikonen, Tuija

doi:10.1177/1457496913482255

Cited by 56 publications

(65 citation statements)

References 29 publications

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“…'It is too much for the doctor to do alone' . 4. Ward nurses presenting a summary of the patient's condition and medical history to the surgeon in the OR before surgery.…”

Section: Resultsmentioning

confidence: 99%

“…In high income countries it is known that successful implementation requires effective and decisive leadership, encouraging active staff participation and ongoing education [4,5]. Neily and colleagues described teamwork training and use of the checklist which involved 2 months of preparation, 1 day training for operating room teams and 3 monthly coaching interviews over a one year period [6,7].…”

Section: Discussionmentioning

confidence: 99%

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Observational study of three different methods of implementing the WHO surgical safety checklist in Guinea

White¹,

Millimouno²

2016

Glob Anesth Perioper Med

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Objective: The World Health Organisation Surgical Safety Checklist improves surgical outcomes in resource poor settings but the best method of implementing the checklist is unknown. We aimed to evaluate three different methods of training in Guinea and evaluated the outcome at 3-6 months.Methods: A total of 13 individuals (4 surgeons, 7 anaesthetists and 2 nurses) from 6 different hospitals underwent 3 methods of training (hospital team training, hospital individual training and classroom only training). None had previous knowledge the checklist. Effectiveness of training was evaluated by hospital visits and structured interview at 3-6 months. Corroborating evidence was obtained from interviews with the Hospital Directors and other staff. Findings:Team training was the most successful. All the hospitals who received team training reported improvements in teamwork, anaesthesia, and infection control. No hospital managed to implement the checklist in its entirety. Anaesthetists who received individual training were unable to implement any changes in their own hospitals. Conclusion:Team training is more effective than individual training in ensuring more of the key steps of the checklist are followed. Our results question the effectiveness of running a one day classroom training for implementation of the WHO checklist for single groups of professionals such as anaesthetists in the absence of support from other members of the operating team.

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“…'It is too much for the doctor to do alone' . 4. Ward nurses presenting a summary of the patient's condition and medical history to the surgeon in the OR before surgery.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Observational study of three different methods of implementing the WHO surgical safety checklist in Guinea

White¹,

Millimouno²

2016

Glob Anesth Perioper Med

View full text Add to dashboard Cite

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“…5,6,11,21,24 Complicationrelated reoperations only represent a small part of postoperative complications and can be viewed as serious adverse events leading to significant morbidity and even increased risk of death. We wanted to focus on this specific patient group to ana lyze the impact of checklist usage on the severe end of the range of adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…In our previous studies on implementation of this checklist in neurosurgical opera tions we discovered a systematic error in the timing of antibiotic prophylaxis. 11,21 Interestingly, the infection rate declined during the implementation of the checklist, even excl. = excluding.…”

Section: Discussionmentioning

confidence: 99%

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

Lepänluoma

Rahi

Takala

et al. 2015

JNS

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OBJECT Use of the WHO surgical checklist has been proven to reduce surgical morbidity and mortality, but its effect on surgical complications requiring reoperation has not been previously studied. The aim of this study was to determine whether the use of the WHO surgical checklist would have an impact on the number and causes of neurosurgical complications leading to a reoperation. METHODS The authors retrospectively gathered information on all neurosurgical reoperations using hospital discharge data as well as the operations and procedures registry, and tracked all primary neurosurgical operations (n = 175) preceding a complication-related reoperation from 2007 to 2011. There were a total of 5418 neurosurgical operations during the study period. For further analysis of electronic patient records, the primary operations were divided into 2 groups based on the time of the WHO surgical checklist implementation in the authors' unit: 103 operations before and 72 after the introduction of the checklist. Observed adverse events and reoperations were categorized as preventable or unpreventable, and the actual use of the checklist during each operation was recorded. RESULTS The overall rate of preventable complication-related neurosurgical reoperations decreased from 3.3% (95% CI 2.7%–4.0%) to 2.0% (95% CI 1.5%–2.6%) after the checklist implementation. The reoperations were mainly due to wound infections, 46% before and 39% after the checklist. All infection-related reoperations proportioned to all neurosurgical operations (2.5% before vs 1.6% after checklist implementation) showed a significant reduction (p = 0.02) after the implementation of the checklist. In particular, there was a significant decrease (p = 0.006) in the rate of preventable infections associated with reoperations, i.e., 2.2% before versus 1.2% after checklist implementation. The overall adherence to checklist use (the “time out” phase) in neurosurgical operations was 78%, and adherence was 70% in primary operations preceding a complication-related reoperation regarded as preventable. CONCLUSIONS The implementation of the WHO surgical checklist in neurosurgery was associated with a decrease in complication-related reoperations, especially those due to preventable infection complications, the majority of which were wound infections. The adherence to checklist use in individual operations after the checklist implementation did not appear to have an impact on the results.

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“…6,9,12,13,14,17,23,32 These checklists, inspired by the aviation industry, have been widely adopted in the US and internationally as a way to avoid surgical complications. 9,15,28,29 Similar to those used in aviation, the checklists serve 3 main functions: first, to ensure that basic safety checks have been performed; second, to ensure that all necessary equipment is present and functioning properly; and third, to promote teambuilding and effective communication.…”

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confidence: 99%

A checklist for endonasal transsphenoidal anterior skull base surgery

Laws¹,

Wong

Smith³

et al. 2016

JNS

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obJective Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. methods An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. results The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management, monitoring, and other special considerations (e.g., Valsalva, jugular compression, lumbar drain, and so on). The Surgical Pause is composed of personnel introductions, planned procedural elements, estimation of duration of surgery, anticipated blood loss and fluid management, imaging, specimen collection, and questions of a surgical nature. The Equipment Pause assures proper function and availability of the microscope, endoscope, cameras and recorders, guidance systems, special instruments, ultrasonic microdoppler, microdebrider, drills, and other adjunctive supplies (e.g., Avitene, cotton balls, nasal packs, and so on). The Closure Pause is dedicated to issues of immediate postoperative patient disposition, orders, and management. coNclusioNs Surgical complications are a considerable cause of death and disability worldwide. Checklists have been shown to be an effective tool for reducing preventable errors surrounding surgery and decreasing associated complications. Although general checklists are already in place in most institutions, a specific chec...

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Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery

Cited by 56 publications

References 29 publications

Observational study of three different methods of implementing the WHO surgical safety checklist in Guinea

Observational study of three different methods of implementing the WHO surgical safety checklist in Guinea

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

A checklist for endonasal transsphenoidal anterior skull base surgery

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