Abstract PR599

Abstract

Background & Objectives: Induction of anesthesia is a time of increased risk for surgical patients, especially in resource poor settings. Some of this risk may be due to errors in preparation, and the use of checklists is an effective strategy for risk reduction. We hypothesized that performance of a Pre-anesthetic Induction Patient Safety (PIPS) checklist would reduce errors in preparation as well as problems such as cardiopulmonary instability. Materials & Methods: A pre-checklist group was established by observing 72 non-consecutive anesthesia inductions in a single operating theater in a large referral hospital in Rwanda. The anesthesia providers were blinded to the data gathering. A baseline of errors in preparation and problems encountered during induction of anesthesia was established by assessing both preparation of critical materials at the time of induction and by observing physiologic instability such as hypoxemia, hypotension, cardiac arrest and death. A nine-point PIPS checklist was created using the frequency and types of deficiencies identified from the baseline risk data. Introduction and implementation of the PIPS checklist into the daily operating theater use included classroom training sessions followed by two weeks of training in the operating rooms. A post-checklist group was established by observing 48 non-consecutive cases during a follow-up period. Results: Baseline group and Intervention group demographics demonstrated no statistically significant differences. There was a significant reduction in problems encountered: hypoxemia, (29.2% vs.4.2%, p = 0.001); hypotension, (13.9% vs. 0%, p = 0.006); key personnel leaving the room during induction, (11.1 vs. 0%, p = 0.021); and overall cases with at least one error in preparation,(94.0% vs. 22.9%, p < 0.001). Major complications, defined as death, cardiac arrest, hypotension, or hypoxia were reduced (25% vs. 4.2%; odds ratio 0.08; 95% CI (0.01; 0.37); p<0.001). Multivariate adjustment did not significantly change these results. Conclusion: Proper performance of a PIPS checklist significantly decreases cardiopulmonary instability during induction and the rate of errors in preparation in a low resource setting.To our knowledge, this is the first study to show that performance of a PIPS checklist can reduce the rate of cardiopulmonary instability as well as reduce errors in preparation in the peri-induction period. This is an important step in establishing evidence to support routine use of a PIPS checklist for patients undergoing surgery.