The design, development, and implementation of a checklist for intraoperative neuromonitoring changes

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to provide an evidence-based algorithm for the design, development, and implementation of a new checklist for the response to an intraoperative neuromonitoring alert during spine surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The aviation and surgical literature was surveyed for evidence of successful checklist design, development, and implementation. The limitations of checklists and the barriers to their implementation were reviewed. Based on this review, an algorithm for neurosurgical checklist creation and implementation was developed. Using this algorithm, a multidisciplinary team surveyed the literature for the best practices for how to respond to an intraoperative neuromonitoring alert. All stakeholders then reviewed the evidence and came to consensus regarding items for inclusion in the checklist.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A checklist for responding to an intraoperative neuromonitoring alert was devised. It highlights the specific roles of the anesthesiologist, surgeon, and neuromonitoring personnel and encourages communication between teams. It focuses on the items critical for identifying and correcting reversible causes of neuromonitoring alerts. Following initial design, the checklist draft was reviewed and amended with stakeholder input. The checklist was then evaluated in a small-scale trial and revised based on usability and feasibility.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors have developed an evidence-based algorithm for the design, development, and implementation of checklists in neurosurgery and have used this algorithm to devise a checklist for responding to intraoperative neuromonitoring alerts in spine surgery.</jats:p></jats:sec>

Neurological complications in adult spinal deformity surgery

“…Ziewacz et al [79] published a checklist for IONM changes in ASD patients and emphasized the importance of a team approach. At time of signal change, the surgeon has several roles which include reducing compression or stretch on the spinal cord, stopping manipulative maneuvers, identifying misplaced implants, performing further decompression if stenosis is present, and reversing deformity correction.…”

“…Management protocols for high-risk spine patients with IONM changes have been developed [79,80]. Ziewacz et al [79] published a checklist for IONM changes in ASD patients and emphasized the importance of a team approach.…”

Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

“…Overall, 7 out of 15 neurosurgical checklists were reasonably designed and applied in general neurosurgery (8,10,11,(13)(14)(15)19), 3 were in vascular neurosurgery (9,17,18), 2 in stereotactic and functional neurosurgery (7,12), another 2 were in spinal neurosurgery (6,16) and 1 was regarding the placement of external ventricular drainage (5). Two of the general neurosurgery checklists were developed to guide and prevent errors in an intraoperative magnetic resonance imaging (MRI) suite (10,15).…”

“…Most of the checklist studies include both elective and emergency cases (8 out of 15) (6,8,10,(13)(14)(15)(16)18). One checklist was applied in elective and voluntarily in emergency procedures (19).…”

“…The reported experience included several possibilities for the person in charge to complete the checklist. These were different persons (neurosurgeon, anesthesiologist and nurse or technologist) for each particular section of the checklist (6/15) (11,(14)(15)(16)(17)19), the attending neurosurgeon (3/15) (6,8,13), the resident performing the procedure (1/15) (5), a neurointerventional fellow (1/15) (18), a clinician in charge who is not from the surgical team (1/15) (12), and the on-duty safety nurse (1/15) (10). In 2 studies, the person in charge of the safety checks was not reported (7,9).…”