Surgical briefings, checklists, and the creation of an environment of safety in the neurosurgical intraoperative magnetic resonance imaging suite

Abstract

<jats:p>Technological advances have made it possible to seamlessly integrate modern neuroimaging into the neurosurgical operative environment. This integration has introduced many new applications improving surgical treatments. One major addition to the neurosurgical armamentarium is intraoperative navigation and MRI, enabling real-time use during surgery. In the 1970s, the American College of Radiology issued safety guidelines for diagnostic MRI facilities. Until now, however, no such guidelines existed for the MRI-integrated operating room, which is a high-risk zone requiring standardized protocols to ensure the safety of both the patient and the operating room staff. The forces associated with the strong 1.5- and 3.0-T magnets used for MRI are potent and hazardous, creating distinct concerns regarding safety, infection control, and image interpretation. Authors of this paper provide an overview of the intraoperative MRI operating room, safety considerations, and a series of checklists and protocols for maintaining safety in this zero tolerance environment.</jats:p>

Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

“…The prevention of all types of wrong site surgery was almost ubiquitously one of the primary goals of the neurosurgical checklists (11/15) (6-8, [10][11][12][13][14][15]18,19). Three of the checklists (3/15) (9,16,17) did not include this item because of their highly specific and narrow areas and sites of action, in which incorrect site surgery did not exist as an option.…”

“…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).…”

“…Two of the general neurosurgery checklists were developed to guide and prevent errors in an intraoperative magnetic resonance imaging (MRI) suite (10,15). These numbers clearly reflected the case distribution in the common neurosurgical practice.…”

“…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).…”