Simulation-Based Trial of Surgical-Crisis Checklists

Arriaga, Alexander F.; Bader, Angela M.; Wong, Judith M.; Lipsitz, Stuart R.; Berry, William R.; Ziewacz, John E.; Hepner, David L.; Boorman, Daniel J.; Pozner, Charles N.; Smink, Douglas S.; Gawande, Atul A.

doi:10.1056/nejmsa1204720

Cited by 491 publications

(265 citation statements)

References 29 publications

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“…For instance, Neily et al 3 found that surgical team training which incorporated surgical checklists along with communication strategies was associated with a significant reduction in surgical mortality. Arriaga et al 4 found that checklists dramatically improved adherence to critical processes of care in simulated scenarios of surgical crises. Studies have suggested that checklists may reduce errors for many reasons, including ensuring that all critical tasks are carried out, encouraging a non-hierarchical team-based approach, enhancing communication, catching near misses early, anticipating potential complications, and having technologies to manage anticipated and unanticipated complications.…”

Section: Strategies For Patient Safetymentioning

confidence: 99%

Surgical checklists: a systematic review of impacts and implementation

2013

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BackgroundSurgical complications represent a significant cause of morbidity and mortality with the rate of major complications after inpatient surgery estimated at 3–17% in industrialised countries. The purpose of this review was to summarise experience with surgical checklist use and efficacy for improving patient safety.MethodsA search of four databases (MEDLINE, CINAHL, EMBASE and the Cochrane Database of Controlled Trials) was conducted from 1 January 2000 to 26 October 2012. Articles describing actual use of the WHO checklist, the Surgical Patient Safety System (SURPASS) checklist, a wrong-site surgery checklist or an anaesthesia equipment checklist were eligible for inclusion (this manuscript summarises all but the anaesthesia equipment checklists, which are described in the Agency for Healthcare Research and Quality publication).ResultsWe included a total of 33 studies. We report a variety of outcomes including avoidance of adverse events, facilitators and barriers to implementation. Checklists have been adopted in a wide variety of settings and represent a promising strategy for improving the culture of patient safety and perioperative care in a wide variety of settings. Surgical checklists were associated with increased detection of potential safety hazards, decreased surgical complications and improved communication among operating staff. Strategies for successful checklist implementation included enlisting institutional leaders as local champions, incorporating staff feedback for checklist adaptation and avoiding redundancies with existing systems for collecting information.ConclusionsSurgical checklists represent a relatively simple and promising strategy for addressing surgical patient safety worldwide. Further studies are needed to evaluate to what degree checklists improve clinical outcomes and whether improvements may be more pronounced in particular settings.

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Section: Strategies For Patient Safetymentioning

confidence: 99%

Surgical checklists: a systematic review of impacts and implementation

2013

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“…The latter were distributed to all wards and to all operation rooms [28]. For example, the recommendations regarding the screening and therapy of preoperative anemia in Frankfurt were integrated into flow charts and are displayed in the surgical ambulances identifying target patient groups.…”

Section: Patient Blood Managementmentioning

confidence: 99%

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Fischer

Zacharowski

Müller

et al. 2015

Transfus Med Hemother

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Introduction: A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods: This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results: 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion: These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program.

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“…Encourage trainees to make use of checking routines during acute crises. Even in the most dire of situationswhen a patient has arrested -using pre-printed checklists improves timely administration of life saving treatment (Arriaga et al 2013). …”

Section: Tipmentioning

confidence: 99%

“…By adopting a systematic framework, the extraneous load of checking can be reduced, allowing trainees to focus on finding mistakes. Often, these frameworks are organized into checklists, which have helped physicians reduce error in a variety of contexts (Wolff et al 2004;Haynes et al 2009;Winters et al 2009;Ely et al 2011;Arriaga et al 2013;Sibbald et al 2013).…”

Section: Tipmentioning

confidence: 99%