Preoperative Checklist Research Articles

ASK! Preoperative Safety Checklist Protocol in Interventional Spine Procedures: A Quality Improvement Study Thirty Month Follow-up

Medical errors can have devastating consequences for patients. Therefore, it is crucial to prevent sentinel and wrong-side events in order to ensure patient safety. One effective tool for achieving this goal is the World Health Organization (WHO) Surgical Safety Checklist, which can be used in conjunction with a pre-procedural, multidisciplinary checklist and physician-led time-out. In a QI project that focused on interventional pain procedures, a pre-procedural, multidisciplinary checklist and physician-led time-out were implemented. Over a period of 30 months and 5,017 procedures, no near misses or incidents were recorded. These preliminary results suggest that the use of multi-disciplinary checklists and attending-led time outs can significantly improve patient safety in interventional pain procedures.

Assessing the Value of a Pre-operative CT Sinus Anatomy Review Tool.

Performing endoscopic sinus surgery requires an intricate understanding of the anatomy of the paranasal sinuses, orbits and skull base. Avoidance of adverse events requires careful review of pre-operative computed tomography (CT) images to recognize potential areas of safety concern. Using a preoperative checklist may aid surgeons in identifying these features. The objective of this study is to determine the educational value of a pre-operative CT sinus review tool and todetermine if itsuse improves identification of important anatomical features.Otolaryngologists from varying practice levels reviewed 2 preoperative sinus CTs, with and without the tool. A 6-item Likert scale questionnaire assessed the operator experience with the tool. The number of high-risk features identified, determination of overall safety risk and difficulty, and time needed for review were compared between the two groups.A total of 18 participants reviewed 36 CT scans. The use of the CT review tool improved identification of important anatomical feature from 47% to 74% on average. All participants agreed that the tool was useful in capturing important anatomical variations in an organized manner and enabled overall assessment of surgical risk and difficulty. The checklist required significantly more time to complete.A preoperative CT sinus tool is perceived to be a useful tool by surgeons who perform endoscopicsinus surgery. The tool requires more time, but increases the number and consistency of high-risk features identified.

If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria

Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study. Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs). Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention. Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record.

159. Antibiotic and diagnostic stewardship surrounding pre-operative testing in patients undergoing cardiac surgery

Abstract Background Despite national guidelines from the US Preventative Services Task Force and the Infectious Diseases Society of America that recommend against screening for asymptomatic bacteriuria (ASB, defined as > 105 CFU of an organism) in most circumstances, pre-operative screening urine culture (UCx) continues. Detection and treatment of ASB leads to antibiotic exposure and risk of antibiotic-associated adverse events like drug reactions, Clostridioides difficile infection (CDI), and colonization by drug-resistant organisms. We describe the implementation of eliminating pre-operative screening for ASB in patients undergoing cardiac surgery. Figure 1Pre-operative checklist for cardiac surgery prior to intervention Methods This was a pre-post study of practice change involving removing ASB screening as part of the pre-cardiac surgery checklist (Figure 1). The pre-intervention period was 08/18/21 – 11/17/21, the post intervention period was 12/1/21 – 3/1/22. We identified all patients who underwent a cardiac arterial bypass graft procedure with or without vein harvesting. We reviewed pre-operative UCx, test indication, antibiotic administration pre-operatively due to culture growth, and post-operative CDI and CAUTI within 30 days post procedure identified through routine infection prevention and control surveillance. Results Pre-intervention, 117/128 (91.4%) patients undergoing cardiac surgery had a UCx collected. Of the UCx, 100% were ordered as part of the pre-operative checklist and not for symptoms. Five patients pre-intervention had ASB detected. Four patients received antibiotics to treat ASB. A fifth patient received antibiotics for bacteriuria which did not meet ASB count threshold. Post-intervention, 15/123 had a UCx (12.3%). Of these, 12/15 were ordered as part of the pre-operative checklist (80%), and the remaining three had symptoms documented. Post-intervention, one patient had ASB detected and did not receive antibiotics. Pre- and post-intervention there were 2 cases of CDI (2/128, 1.6% and 2/123, 1.6%, respectively). There were no CAUTIs either pre- or post-intervention. Conclusion Standard pre-operative UCx is known to be a low-value test and is not recommended by national guidelines. In this single-center diagnostic stewardship intervention, screening was reduced by 87.2%. There was no change in infectious outcomes. Disclosures All Authors: No reported disclosures.

Internal Jugular Vein Tumor Thrombus: A Tricky Question for the Thyroid Surgeon

Internal jugular vein tumor thrombus is an extremely rare condition in thyroid carcinoma, but it does exist. Correlated with greater aggressiveness with a higher incidence of distant metastases at diagnosis and a higher recurrence rate, this important prognostic element should be systematically investigated by ultrasound operators in all patients presenting with thyroid carcinoma. The patient's follow-up must be careful. This can be a trap that surgeons must look for in their preoperative checklist. We report the case of a 58-year-old woman with an IJV thrombus associated with multiple bone metastases. She underwent successful surgical treatment, and postoperative pathology showed a poorly differentiated follicular carcinoma of the thyroid and a tumor thrombus in the internal jugular vein.

The Next Step: Use of a Pre-Operative Checklist to Prevent Missteps.

The Next Step: Use of a Pre-Operative Checklist to Prevent Missteps.

Supervision of Surgical Trainees During Operative Procedures: Implementation of a Formal Preoperative Surgical Checklist.

Background Trainers in surgery have an educational obligation to train trainees in performing operative procedures. Objective We hypothesized that poor concordance manifests as discrepancies between the trainee and the trainer, with an associated reduction in satisfaction with the training experience, perception of training quality, and completion of workplace-based assessments (WBAs). This study also aimed to validate the novel Supervised Training Operative Procedure (STOP) online tool. Method We developed an online proforma (STOP online tool) and conducted a prospective, single-blinded study of 53 orthopedic operative procedures with 53 traineesbetween January 19, 2019, and August 27, 2019. Results Forty-four (82%) trainees were listed as the primary surgeon. The overall mean trainee satisfaction (on a 0-10 Likert scale) was 8.25 (range: 3-10), and the mean trainer satisfaction was 8.28 (range: 4-10). A preoperative discussion between the trainee and the trainer occurred in 96.2% of the cases. Forty-eight (91%) trainers preoperatively established trainees' objectives and 91% (n = 48) of the cases showed postoperative completion of objectives. Forty-four (83%) trainers anticipated workplace-based assessment(WBA) completion for trainees, and this translated into 41 (77%) completed WBAs. Overall, 47 (92.9%) trainees felt that the STOP tool would be useful as a surgical training checklist and in the completion of WBAs. Conclusion The STOP checklist is useful in understanding qualitative and quantitative measures of the overall trainee performance of an operative case. This holistic approach will enable us to establish a structured perioperative surgical training checklist, as trainee and trainer requirements are dependent on one another.

Retropalatal and retroglossal spaces evaluation: a CT study

BackgroundThe retropalatal and retroglossal spaces are the main affected areas in obstructive sleep apnea (OSA) and they are the main targeted regions during OSA surgeries. But the dimensions of these spaces are sparsely referred to in literature.AimTo measure the retropalatal and retroglossal spaces dimensions in an easily measured way on the radiological evaluation to put basic measurements for such areas in normal subjects by multislice computed tomography (MSCT) in adults.MethodsMSCT scans of asymptomatic adults were done for all included subjects to obtain delicate anatomical details of the recess using coronal, axial, and sagittal reformatted capability. Each retropalatal and retroglossal space was revised in the CT to find and measure their dimensionsResultsWithin included 100 subjects, the mean transversal diameter (width) of the retropalatal space was 16.7±3 mm axially and the mean anteroposterior diameter (depth) was 6.9±1.4 mm. At the retroglossal area, the mean transversal diameter (width) was 17.7±3.8 mm axially and the mean anteroposterior diameter (depth) was 10.1±1.95 mm.ConclusionThe current work describes the measurements of the retroglossal and retroplatal spaces. It is recommended to add the retroglossal and retropalatal space dimensions to the preoperative CT checklist, particularly in OSA.

EP-488 Pre-operative electronic checklists as a systematic method to improve patient care

AimsThe COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays.MethodsAn audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care.ResultsThe implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained.ConclusionCOVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.

Integration of the 'Snipping' Tool to the Pre-operative Checklist: A Technical Note.

Integration of the 'Snipping' Tool to the Pre-operative Checklist: A Technical Note.

P20 Pre-operative checklist to improve pathway for carotid endarterectomy (CEA) patients: a single centre audit

Abstract Introduction The SARS-COV-2 pandemic has led to the redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOP) was proposed. An audit was undertaken to evaluate the SOP, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Methods To ascertain key pre-operative steps to include in the checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once the checklist was established the questionnaire was re-sent additionally asking for feedback on its impact on the service and suggestions for improvement. Using these results, the checklist was incorporated as a smart text to EPIC (electronic patient notes). Results The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt the checklist improved the service in all domains, except bed availability and subsequent surgical delay, likely because this depended on HDU bed availability and need for on-the-day prioritisation. Conclusion The CEA surgery checklist is now an established part of the electronic patient record in the form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of the team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message With the move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by the use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.

Lariboisiere Hospital pre-operative surgical checklist to improve safety during transpetrosal approaches.

Transpetrosal approaches are technically complex and require a complete understanding of surgical and radiological anatomy. A careful evaluation of pre-operative magnetic resonance imaging and computed tomography scan is mandatory, because anatomical or pathological variations are common and may increase the risk of complications related with the approach. Pre-operative characteristics of venous and petrous bone anatomy were analysed and correlated with intraoperative findings, using injected magnetic resonance imaging and thin-slices computed tomography scan. These data regularly checked before each transpetrosal approach were progressively included in the presented checklist. Transpetrosal approaches have been used in 101 patients. Items included in the checklist were petrous bone pneumatization, angle between petrous apex and clivus, dehiscence of petrous carotid artery, dehiscence of geniculate ganglion, distance between superior semicircular canal and middle fossa floor, distance between cochlea and middle fossa floor, sigmoid sinus dominance, transverse sigmoid sinus junction depth to the outer cortical bone, jugular bulb height (high or low), location of the vein of Labbé, characteristics of superior petrosal vein complex. The presented checklist provides a systematic scheme of consultation of characteristic of venous and petrous bone anatomy for transpetrosal approaches. In our experience, the use of this checklist reduces the risk of complications related with approach, by minimizing the neglect of crucial information.

Development of an Evidence-Based Pediatric Preoperative Risk Assessment Checklist

PurposeTo describe how a pediatric preoperative risk assessment (PPRA) checklist was developed to inform perianesthesia nurses of potential postanesthesia care unit (PACU) respiratory complications. DesignEvidence-based practice approach. MethodsA systematic search was conducted using PubMed, CINAHL and Cochrane Library databases for this project. In addition, an integrative review process was conducted to develop an assessment checklist of evidence-based pediatric preoperative risk factor criteria associated with PACU respiratory complications. Evidence-based review focused on summarizing and appraising current research for quality levels for each of the individual pediatric preoperative risk factor that comprised the assessment checklist. FindingsEleven risk categories were established: Age, American Society of Anesthesiologists Physical Status, gender, general anesthesia, airway comorbidities, syndromes/congenital anomalies, pulmonary comorbidities, African American ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities. Multidisciplinary experts came to consensus on content and face validity as well as reliability of the PPRA checklist. ConclusionsThe PPRA checklist presents a rapid way to communicate through handoff the preoperative “big picture” to interpret children's acuity and comprehensive risk for significant pediatric respiratory adverse events in the PACU.

Paediatric tonsillectomy and adenotonsillectomy in a rural setting: a retrospective study over a period of 6-years.

Swan Hill District Health (SHDH) provides Otolaryngological services to outer regional Victoria. A preoperative checklist determines eligibility for tonsillectomy, and the role of preoperative investigations such as oximetry. Visiting specialists who provide T&A also remain on-site for 24 h post-surgery. Management of post-discharge complications is supported by SHDH's Emergency Department. Unstable patients are transferred to tertiary care hospitals. This study examines the safety outcomes associated with rural Tonsillectomy and adenotonsillectomy (T&A) and the impact of peri-operative protocols on these outcomes. This is a retrospective cohort study of all paediatric (2-18 years old) patients undergoing T&A from August 2014 to June 2020 at SHDH. Four external hospital databases which accept patient transfers from SHDH were searched for T&A-related complications. The primary outcome was complication incidence. Secondary outcomes were length of stay, and rates of hospital readmissions, return to theatre and inter-hospital transfer. Two hundred and four patients were included, with median age 6 years old; 68.1% (n=139/204) had obstructive sleep apnoea, or sleep disordered breathing, wherein 36.0% (n=50/139) had documented evidence of normal/inconclusive oximetry. The complication rate is 6.9% (n=14/204), with two intraoperative, five perioperative and seven post-discharge complications. All intra- and peri-operative complications were managed locally. All post-discharge complications presented to outer regional EDs. Two patients required inter-hospital transfer for monitoring of post-tonsillectomy bleeds in a specialist unit. Patients who pass a preoperative risk checklist can safely undergo T&A in selected rural settings which adhere to strict patient selection criteria and implement safety measures to address complications.

Thực trạng tuân thủ quy trình chuẩn bị người bệnh trước mổ phiên tại bệnh viện Chợ Rẫy thành phố Hồ Chí Minh năm 2021

A cross-sectional study was employed to describe the situation of compliance with patient preparation before surgery session of nurses at Cho Ray Hospital in 2021. This study was conducted from 03/2021 to 08/2021, by using an observational checklist of 113 prepared surgeries. The results showed that the compliance rate of patient preparation checklist at Cho Ray Hospital was 75.2%. In which, the highest compliance rate with the checklist was the stage of patient handover (85.8%), followed by 78.8% in the preparation stage and 75.2% in the stage of transferring the patient to surgery. The rate of adherence to the preoperative preparation procedures at the Department of Neurology and the Department of General Surgery was 76.2% and 74.0%, respectively. In conclusion, the compliance rate with the checklist is quite high, however, it is still necessary to organize the training for nurses to improve their personal awareness and practice of the pre-operative patient preparation checklist. Keywords: Preparation before surgery, Cho Ray Hospital.

Followership: The Missing Link in Surgical Leadership.

Followership: The Missing Link in Surgical Leadership.

The Burden of Surgical Cancellations: A Quality Improvement Study on the Importance of Preoperative Assessment.

BackgroundThe operating room (OR) is a critical facility that consumes a significant percentage of the hospital's resources, so it must be used judiciously. Surgical cancellation is a chief cause of OR underutilization. The purpose of this study was to hold medical concerns accountable for surgical cancellations at a large tertiary care hospital in Maharashtra, India.MethodsThe Plan, Do, Study, and Act (PDSA) cycle is a tool for analyzing change and learning via action. We used this method to determine the origins of errors, identify key points, and test change interventions such as an individually tailored anesthetic plan, provision of a pre-anesthesia evaluation clinic in the outpatient department, reevaluating patients, and rechecking the preoperative checklist. This study was undertaken as a part of a quality improvement project at our hospital in India. All elective surgical operations scheduled between January and November 2020 were included, and canceled procedures were investigated to identify potential reasons.ResultsDuring the auditing period, 7,709 elective operations were scheduled; 68 (0.88%) of them were canceled. After piloting interventions, the rate of cancellations dropped from 1.08% to 0.67% in the succeeding cycle. A root cause analysis of the data revealed that there was a 7.1% decrease in cancellations due to hypertension, a 3.8% decrease due to insufficient routine blood tests, and a 1.9% decrease in the inappropriate preoperative workup, while we saw an increase in fever (5.5%) and blood sugar level (1.9%) discrepancies.ConclusionsDr. D. Y. Patil Hospital & Research Centre in Pune, India, had cancellations in scheduled ORs due to associated medical co-morbidity that were potentially reducible post-intervention and could be replicated for application in various tertiary care hospitals. Regular monthly audits, quality improvement projects, and the designation of an organized system may enhance the proper utilization of the OR which could potentially save funds, preserve resources, alleviate the burden of patients, and reduce cancellations to a minimum.

Cavography with hydrogen peroxide. Accidental injection of hydrogen peroxide into the inferior vena cava

Contrast cavography during removal of a vena cava filter in patients treated via thrombectomy for pulmonary embolism is a widely performed procedure, which may involve potentially serious complications if the human factor fails. Accidental injection of hydrogen peroxide (H2O2) after mistaking it for contrast material can have fatal consequences. We present the case of a patient who was accidentally injected with a high quantity of hydrogen peroxide. The preparation of a preoperative checklist, the amount of H2 02 injected and the operator’s skill in aspirating the substance are decisive factors in avoiding such complications.

Preoperative checklist to reduce the risk of cardiac implantable electronic device infections.

Cardiac implantable electronic device (CIED) infection represents a dramatic event with a high mortality rate (>3x) despite antibiotic therapy and device extraction; therefore, the real winning strategy in this situation could be represented by prevention. Antibiotic prophylaxis and antibiotic-releasing envelope are effective in improving patient outcome; however, healthcare costs related to CIED infections remain high over the years. In this review we would keep the attention on a pre-surgical checklist to reduce the risk of CIED infections. In fact, checklist is an effective instrument for medical care quality improvement mainly used in surgery, but not very commonly in cath-lab and electrophysiology procedures. All steps of this checklist are of proven effectiveness in reducing the risk of CIED infections but, up till now, they are not considered together in a pre-surgical approach.

Retromaxillary recess of the sphenoid sinus: an overlooked recess

BackgroundRetro-maxillary recess of the sphenoid sinus is an area that is yet to have appropriate description in the literature and usually overlooked. The objective of the current study was to determine the incidence and detailed description of the retromaxillary recess of the sphenoid sinus by multi-slices computed tomography (MSCT) in adults. Paranasal MSCT scan of asymptomatic adults was done for all our subjects to obtain delicate anatomical details of the recess using coronal, axial, and sagittal reformatted capability. Each sphenoid sinus in the CT was revised to find and describe the retro-maxillary recess of the sphenoid sinus regarding its extensions and dimensions.ResultsThis study included 100 adult subjects (200 sphenoid sinuses); retro-maxillary recess was detected in 16.5% (33 sides) of them using MSCT. They were distributed in 20 subjects (20% of all examined sphenoid sinuses). Sixty-five percent of reported recesses were bilateral. Range of antero-posterior diameter (depth) of the recess was 3.9 to 14 mm while its width range was 1.1 to 9 mm. The thickness of the bony septum between the recess and the maxillary sinus ranged from 0.2 to 3.2 mm.ConclusionCurrent work described in details the retromaxillary recess in CT and its nearby surrounding important structures in all directions. From our results, it is recommended to add the retromaxillary recess of the sphenoid sinus to the preoperative CT checklist particularly in revision cases.