Crisis Checklists for the Operating Room: Development and Pilot Testing

Ziewacz, John E.; Arriaga, Alexander F.; Bader, Angela M.; Berry, William R.; Edmondson, Lizabeth; Wong, Judith M.; Lipsitz, Stuart R.; Hepner, David L.; Peyré, Sarah E.; Nelson, Shakira M.; Boorman, Daniel J.; Smink, Douglas S.; Ashley, Stanley W.; Gawande, Atul A.

doi:10.1016/j.jamcollsurg.2011.04.031

Cited by 214 publications

(170 citation statements)

References 84 publications

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“…Standard operating procedures and checklists are an integral part of safe practice in many high reliability organisations, internationally [95]. Relevant checklists for anaesthesia and surgery include the 'Crisis Management Manual' from the Australian Patient Safety Foundation [96], a new crisis checklist from Gawande's group at the Harvard School of Public Health [97] and the World Health Organization's Safe Surgery Checklist, which includes an airway component [98]. The Fourth National Audit Project also recommended use of checklists and standard operating procedures for a number of circumstances such as intubation outside the operating theatre and rescue of the accidentally dislodged airway in the intensive care unit [1].…”

Section: The Potential For Simulation To Enhance Learningmentioning

confidence: 99%

Education in airway management

et al. 2011

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SummaryIn airway management, poor judgment, education and training are leading causes of patient morbidity and mortality. The traditional model of medical education, which relies on experiential learning in the clinical environment, is inconsistent and often inadequate. Curriculum change is underway in many medical organisations in an effort to correct these problems, and airway management is likely to be explicitly addressed as a clinical fundamental within any new anaesthetic curriculum. Competency‐based medical education with regular assessment of clinical ability is likely to be introduced for all anaesthetists engaged in airway management. Essential clinical competencies need to be defined and improvements in training techniques can be expected based on medical education research. Practitioners need to understand their equipment and diversify their airway skills to cope with a variety of clinical presentations. Expertise stems from deliberate practice and a desire constantly to improve performance with a career‐long commitment to education.

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Section: The Potential For Simulation To Enhance Learningmentioning

confidence: 99%

Education in airway management

et al. 2011

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“…15 An area in which the checklist itself may prove most beneficial is during urgent or emergent operations or operating room crises. 28,51,54 Despite physicians' perception that they are able to perform similarly under emergent and normal circumstances, 27,44 evidence from the literature suggests that this is not the case. 3,5,34,43 Surgical emergencies and operating room crises are stressful, time-critical events requiring rapid and coordinated management to provide the best chance of successful outcome.…”

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confidence: 99%

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

Ziewacz¹,

Berven

Mummaneni³

et al. 2012

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Object 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. Methods 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. Results 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. Conclusions 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.

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“…10,16,30 These general checklists serve an important function in averting catastrophic surgical complications, such as wrong-site, wrong-procedure, or wrong-patient operations. 22,39 They similarly help prevent adverse surgical outcomes by ensuring basic steps for patient safety, such as identifying a patient's allergies and encouraging sterility in the operating room. 4,14,16,34 Systematic reviews of the introduction and implementation of these checklists have been overwhelmingly positive, with general decreases in surgical complication rates and reports of improved operating room teamwork and communication.…”

Section: Discussionmentioning

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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Crisis Checklists for the Operating Room: Development and Pilot Testing

Cited by 214 publications

References 84 publications

Education in airway management

Education in airway management

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

A checklist for endonasal transsphenoidal anterior skull base surgery

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