Preoperative Checklist Research Articles

Troubleshooting common endoscopic malfunctions: a study integrating a preoperative checklist and troubleshooting guide into surgical resident training.

This study assessed the utility of a checklist in troubleshooting endoscopic equipment. Prior studies have demonstrated that performance in simulated tasks translates into completion of similar tasks in the operating room. Checklists have been shown to decrease error and improve patient safety. There is currently limited experience with the use of simulation and checklists to improve troubleshooting of endoscopic equipment. We propose the use of a checklist during a simulated colonoscopy to improve performance during endoscopic troubleshooting. This study randomized 20 surgical residents (PGY1-3) who were blinded to the purpose of the simulation. Participants were asked to complete two consecutive colonoscopies in a mock endoscopy suite. Prior to each trial, a standard set of equipment malfunctions were created; the equipment was returned to working order if the subjects were unable to successfully troubleshoot the equipment within the first 3min of the simulation. Between trials, the intervention group was provided a troubleshooting checklist, which they were permitted to utilize during the second trial. The control group had no intervention. Scores were calculated for each task by subtracting time to completion from total time allowed (180s), with 0 indicating the task was not completed. Groups were compared utilizing unpaired Student's t-test with p<0.05 threshold for significance. Average scores were compared for 5 tasks in the first trial and 6 tasks in the second trial. During the first trial, there were no significant differences. However, during the second trial, there was a significant improvement with the checklist for 5/6 tasks. Use of a checklist, with no further intervention, significantly improves the ability of novice endoscopists to identify and remedy common equipment malfunctions. Introduction of a troubleshooting checklist may represent a simple and low-cost way to improve both efficiency and safety in the endoscopy suite.

Sleep surgery tool: A medical checklist to review prior to operating

ObjectiveThe objective of this study was to systematically review the international literature for studies providing a preoperative checklist for medical disorders to be evaluated or treated before performing sleep surgery. If no checklist exists, then studies providing recommendations would be used to develop a checklist de novo. Study designSystematic review combined with expert opinion. MethodsFour databases, including PubMed/Medline were searched through August 10, 2016. Results453 potentially relevant studies were screened, 32 were downloaded for full review. No study included a preoperative checklist. No study provided guidance for specific medical disorders to evaluate or screen for prior to sleep surgery. Therefore, we reviewed articles in adults that provided recommendations such as: (1) labs to review, (2) non-operative disorders to evaluate and treat, and (3) comorbidities to optimize prior to performing sleep surgery. These articles were utilized in conjunction with expert opinion to develop a preoperative checklist for surgical guidance. ConclusionThere are several items to review prior to performing sleep surgery on obstructive sleep apnea patients. This systematic review and expert opinion-based checklist provides over twenty items for reviewing prior to performing sleep surgery to reduce the chance of operating prematurely.

A guide to open surgical tracheostomy

Open tracheostomy procedure is one of the oldest described surgical interventions. It involves the creation of a stoma at the skin surface of the anterior neck leading to the trachea. There are multiple indications for such procedure. It can be used as a solution for upper airway obstruction of multiple aetiology, in cases of prolonged mechanical ventilation where there is the need to replace endotracheal intubation and for airway protection as part of another surgical procedure. In the preoperative phase, it is important to ensure adequate consent is present and that a preoperative check-list is followed, including reviewing investigations and familiarisation with available tracheostomy tubes. The operative technique should be performed in a logical systematic way. One should first ensure adequate surgical environment and proper patient positioning. Marking of anatomical landmarks is advised. Infiltration with local anaesthetic containing adrenaline solution is advocated. The surgical steps involved are followed stepwise. The skin incision is adequately placed, dissection through fascia and separation of strap muscles vertically with their lateral retraction performed. One should then identify trachea and deal with the thyroid isthmus. The correct site for the tracheotomy is identified and this is performed whilst liaising with the anaesthetist and scrub nurse. The chosen tracheostomy tube should be checked and inserted appropriately. There are some post procedure considerations and checks that should be followed including securing the tracheostomy tube. It is also imperative to recognise and deal with difficult anatomy scenarios. Various early and late complications may arise and appropriate knowledge is essential to avoid them. Early recognition will lead to better patient outcomes. Although there are many variations in performing a classical open surgical tracheostomy, these are all based on a standard technique composed of few fundamental steps, which if followed lead to the performance of a safe surgical procedure.

Derivation and validation of an automated electronic search algorithm to identify patients at risk for obstructive sleep apnea

Background. Automated extraction of data from electronic health records has allowed high-quality retrospective analyses of large cohorts. Objectives. To derive and validate an au-tomated electronic search algorithm to identify surgical patients with a diagnosis of or at high risk for obstructive sleep ap-nea (OSA).Methods. From 558 adult patients who underwent surgery from January 1, 2011, through December 31, 2015, we construct-ed a derivation cohort of 100 subjects se-lected using the initial search algorithm to have equal numbers of patients with high and low likelihood of having OSA. This algorithm conducted a free-text electronic search of patient diagnoses and interro-gated results of a preoperative checklist that specifically queried patients regarding OSA history and screened for OSA risk us-ing Flemons criteria. The derivation cohort was then manually reviewed to identify patients with OSA risk and results were used to refine the algorithm. Second, the algorithm was validated with the other 458 patients (the validation cohort). The sensi-tivity and specificity were compared again with manual chart review of the respective group.Results. In the derivation cohort, the auto-mated electronic algorithm achieved a sen-sitivity of 98.2% and a specificity of 100.0% compared with the manual review. In the validation cohort, sensitivity was 100.0% and specificity was 98.4% in this compari-son.Conclusion. An automated electronic search algorithm was developed that interrogates electronic health records to identi-fy, with a high degree of accuracy, surgical patients with a diagnosis of or at high risk for OSA.

Preoperative investigations of open heart surgical patients: Our current institutional protocol (1)

Background: Open heart surgery is one of the complex procedures physicians undertake in modern medicine. It requires high tech equipment, special infrastructure and highly skilled manpower, especially in the areas of cardiology, cardiac surgery, anaesthesiology and cardiac perfusion. Preoperative diagnosis must be accurate and patients’ safety determined in order that appropriate informed consent is given. In open heart surgery, our institution developed preoperative assessment protocol. They are clinical evaluation and preoperative investigations.The objective of this study is to highlight our institutional preoperative investigative protocol and compare same with what is available in the literature.Materials and Method: In our institution, the first open heart surgery was done in 1974. We performed a retrospective review of the preoperative investigation protocols from 1974 to 2016, spanning a period of 42 years noting the changes and outcome of the changes. The 42 years of cardiac surgery activity occurred in 3 phases: 1. from 1974 – 2000; 2. 2003; 3. 2013 – 2016. Data were obtained from our hospital Record Department. The types of the preoperative investigative protocol and outcome of the changes were analyzed using Microsoft excel and results expressed in arithmetic percentages and presented in tables and bar chart.Results: These investigations are broadly divided into diagnostic and patient’s fitness assessment investigations. The diagnostic investigations aid proper clinical evaluations and are used in evaluating congenital heart defects and acquired heart diseases. In addition, fitness assessment tests have two functions and they are 1. determining the risks of postoperative morbidity and mortality from patients’ co-morbidities and the systemic effects of the cardiac disease(s). 2. Predicting the postoperative support that may be required in order to maximize the chances of uneventful surgery. The diagnostic and fitness investigations guide the quartet (cardiologist, cardiac surgeon, cardiac anaesthetist and cardiac perfusionist) in making appropriate management decisions especially with regard to complex congenital heart defects and complex cardiac cases in the elderly, discussed in the setting of cardiac team meetings.Conclusion: Preoperative investigations form part of an intrinsic preoperative checklist to ensure where possible uneventful surgery. When they are holistically done and accurate diagnosis is made including patients properly worked up via-a-vis the results of the investigations, the outcome is bound to be favourable.Keywords: complex, congenital, diagnostic, preoperative, investigation

Using a STOP/GO protocol in the preoperative area to increase patient safety.

A multitude of surgeries are performed each year and 15% of cases have an adverse event, most of which are preventable. A culture of safety must be adopted by the entire surgical team. A preoperative checklist in addition to the intraoperative checklist can help decrease errors. We adapted a Stop/Go process in the preoperative area which had to be completed prior to moving the patient into the operating room. We examined adverse events before and after this process. Adverse events decreased from 1.5% to nearly 0% over the time examined. The Stop/Go preoperative checklist, adapted to our specific operating room needs, helped to decrease adverse events.

Clinical risk management - a 3-year experience of team timeout in 18081 ophthalmic patients.

Clinical risk management aims to identify, analyse and avoid errors and risks systematically to improve patient's safety. Preoperative checklists to prevent mistakes have gained importance in the last few years. A so-called team timeout checklist was introduced in October 2011 at the Department of Ophthalmology, Hietzing Hospital, Vienna. The purpose of the study is to evaluate the benefits and demonstrate the value of team timeout. After the team timeout had been in use for 6months, all near misses that occurred over a period of 34months were assigned to the following groups: wrong side, wrong lens, wrong patient and miscellaneous. Eighteen thousand and eighty-one surgeries were performed in the specified period; 53 cases of 'wrong side' and 52 cases of 'wrong intraocular lens' were noted. Ninety-six near misses concerned the patients' data and 38 concerned documentation. A reduction of near misses was noted after an adaptation phase of 3months. Team timeout proved valuable, as it improved the patients' safety with minimum effort. Errors may occur despite several preoperative controls and can be detected by performing team timeout.

Interface transition checklists in spinal surgery.

Recently, quality tools have been promoted to improve patient safety andprocess efficiency in healthcare. While surgeons primarily focused on surgical issues, like infection rates or implant design, we introducedpre-admission and preoperative checklists in the early 2000s. To assess the efficiency of these tools in a neurosurgical department, we performed a survey of all spinal instrumentation patients operated in 2011 (n=147). The results revealed several problems. We consequently redesigned the checklists accompanied by flanking measures, such as written and online accessible standards. Furthermore, the staff was trained to use the updated quality tools. The measures were implemented in 2012. Results were re-evaluated in a second survey in 2013 (n=162). We found that the use of pre-admission checklists significantly increased from 47 to 96%, while the use of preoperative checklists significantly decreased from 86 to 75%. Within the same period, the quality and completeness of the checklists did, however, increase, so that in 2013, 43% of the patients had a completely processed preoperative checklist, compared to 29% in 2011. The introduction of checklists alone did not in itself guarantee an improved workflow. The introduction must be accompanied by other measures, like written standards and regular training of employees. Otherwise, the positive effect wears off quickly. Nevertheless, we could show that the stringent application of quality tools can induce a sustainable change. Our data further suggest that the clear and traceable delegation of responsibilities is of high importance.

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes.

Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications. To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine. Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital, with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection, attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64, 95% CI 0.57 - 0.71; p&lt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59, 95% CI 0.21 - 1.70; p=0.33, cardiac complications RR 0.74, 95% CI 0.28 - 1.95; p=0.54, infectious complications RR 0.61, 95% CI 0.29 - 1.27; p=0.18, and perioperative bleeding RR 0.36, 95% CI 0.23 - 0.56; p&lt;0.00001. There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent.

Efficacy of surgical safety checklist: Assessing orthopaedic surgical implant readiness

IntroductionOur institution employs a Surgical Universal Protocol Preoperative Checklist in accordance with World Health Organization guidelines to promote patient safety. It is used in part to evaluate orthopaedic surgical equipment and implant readiness prior to the initiation of each surgical case. Our goal is to measure the preoperative checklist's efficacy in assessing orthopaedic equipment readiness preoperatively and its ability to prevent orthopaedic equipment failures (OEF). Our study focused on orthopaedic surgery cases as they require a large volume of equipment and implants for successful completion. These cases therefore present an appropriate medium to identify potential weakness in our institution's current surgical safety checklist (SSC). MethodsData was collected over a 6 month period of time, broken into 2 distinct periods. The goal during the first 3 months was to observe compliance with the SSC. And during this time, we observed how often the SSC identified an implant or equipment deficiency at the outset of the case. The goal during the second 3 months was to record if orthopaedic surgical equipment issues were occurring that should have been identified by the SSC. During the second 3 months, we continued to utilize the SSC but also added a postsurgical review at the end of each surgical case. The postsurgical review was a one page questionnaire aimed at identifying any orthopaedic equipment failures that had occurred during the surgical case. For the purposes of this study, we defined an intraoperative orthopaedic equipment failure (OEF) as any one of the 6 following categories: (1) surgery delayed due to missing equipment, (2) lack of sterility of equipment, (3) equipment not available, (4) equipment malfunction, and (5) equipment sets incomplete, or (6) additional equipment brought into room necessary for completion of case. The data was collected at a postsurgical review that was performed by the physicians, nurses, and technicians from the surgical team in a nonthreatening manner. We also attempted to quantify the impact that the OEF had upon the surgical case. ResultsDuring the first 3 months of the study (phase 1), we confirmed that our institutional SSCs were completed for all orthopaedic cases, including the specific questions related to implants and equipment. During phase 1, using the SSC alone, no orthopaedic equipment failures were identified. During phase 2, 33% of the reported surgical cases were identified as having started without essential equipment available or operational (defined as an orthopaedic equipment failure) in the operating room. The most common negative impact upon the surgical case was additional time requirement. ConclusionOur institution's current SSC fails to prevent OEF in our operating rooms. These checklist failures and intraoperative equipment deficiencies have measureable negative patient safety and institutional cost implications. ImplicationsWhile the SSC is an effective tool it cannot be used alone to prepare for orthopaedic surgical cases. In order to improve patient safety and decrease hospital losses, further research is necessary to implement an effective communication network between surgeons, administrators, operating room nursing and sterile processing to eliminate OEF. Level of evidenceLevel IV.

The collaborative development of a pre-operative checklist: An e-Delphi study

The aim of this study was to identify which items should be included in a pre-operative checklist based on recommendations by nurse experts in order to promote patient safety and effective communication in the perioperative environment. Method: Thirty-five nurses participated in this e-Delphi study, which was conducted online via SurveyMonkey . Each survey presented participants with a list of potential items for inclusion in a pre-operative checklist. Participants were asked to identify items they felt should be included in the checklist with the option to include comments. Comments were de-identified and shared with other participants to allow confidential interaction. The surveys were analysed for consensus, determined as agreement between at least 70% of participants. Results: Three survey rounds were completed. Forty-six items achieved consensus for inclusion in a pre-operative checklist. Conclusion: The 46 items which achieved consensus were condensed to a list of 25 items categorised as: 1. Patient and procedure verification; 2. Preparation; and 3. Assessments. The findings of this study provide an evidence base for development of pre-operative checklists, to promote patient safety and effective communication in the perioperative environment.

Chewing gum in the preoperative fasting period: an analysis of de-identified incidents reported to webAIRS.

The role of preoperative fasting is well established in current anaesthetic practice with different guidelines for clear fluids and food. However, chewing gum may not be categorised as either food or drink by some patients, and may not always be specified in instructions given to patients about preoperative fasting. The aim of this paper was to review anaesthesia incidents involving gum chewing reported to webAIRS to obtain information on the risks, if any, of gum chewing during the preoperative fasting period. There were nine incidents involving chewing gum reported between late 2009 and early 2015. There were no adverse outcomes from the nine incidents other than postponement of surgery in three cases and cancellation in one. In particular, there were no reports of aspiration or airway obstruction. Nevertheless, there were five cases in which the gum was not detected preoperatively and was found in the patient's mouth either intraoperatively or postoperatively. These cases of undetected gum occurred despite patient and staff compliance with their current preoperative checklists. While the risk of increased gastric secretions related to chewing gum preoperatively are not known, the potential for airway obstruction if the gum is not detected and removed preoperatively is very real. We recommend that patients should be specifically advised to avoid gum chewing once fasting from clear fluids is commenced, and that a specific question regarding the presence of chewing gum should be added to all preoperative checklists.

Health Services Research and Regionalization of Care-From Policy to Practice: the Ontario Experience in Head and Neck Cancer.

Patients being treated at higher case volume hospitals or by higher case volume physicians appear to have better outcomes. This volume-outcome relationship is reviewed for oncologic and non-oncologic surgery with a focus on head and neck oncology. The impact of these research findings on health policy and health-care organization in Ontario, Canada, is then outlined. Lastly, future directions for quality improvement in surgical oncology are reviewed in the context of a universal health-care system. These include surgeon report cards, pre-operative checklists, linking funding and remuneration to the quality of delivered care, and the use of process improvement techniques.

Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

ObjectivesTo assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial).DesignMulticenter, two-arm, parallel-group, open-label randomized controlled trial.Setting11 university hospital ambulatory surgery units in Paris, France.ParticipantsPatients scheduled for ambulatory surgery and able to be reached by telephone.InterventionA 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Main Outcome MeasuresRate of cancellation on the day of surgery or the day before.ResultsThe study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state.ConclusionsA standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.Trial RegistrationClinicalTrials.gov NCT01732159

The design and application of electronic preoperative preparation checklist

Objective To design and formulate a electronic preoperative preparation checklist for applying in the preoperative preparation, to reduce missing rate in preoperative preparation and transfer,to improve patient satisfaction, to avoid operation delay and medical accident caused by inappropriate preparation. Methods A total of 145 patients with surgery from March 2013 to February 2013 were as experimental group, and 158 patients with surgery from March 2012 to February 2012 were as control group. The experimental group was used electronic preoperative preparation checklist for preoperative preparation and transition, and the control group was used conventional methods.The incidence of mistake for preoperative preparation and transfer and both surgeon's and patient's satisfactory were compared between two groups. Results After applying the electronic preoperative preparation checklist, the incidence of mistake for preoperative preparation and transfer in experimental group reduced significantly to 1.37% (2/145) and 4.83% (7/145), compared with the incidence of control group 6.33%(10/158),11.39%(18/158), and the differences between two groups were statistically different (χ2=4.870, 4.305,P<0.05). Both surgeon's and patient's satisfactory were improved dramatically, the satisfactory in experimental group improved to 100.00%(50/50) and 97.93%(142/145), compared with the satisfactory of control group 90.00%(45/50) and 90.51%(143/158), and the differences between two groups were statistically different(χ2=5.263, 7.459,P <0.05). Conclusions Implementing the electronic preoperative preparation checklist can reduce the incidence of mistake before operation and ensure patient operation schedule. Therefore, it could improve nursing care quality and efficiency. Key words: Nursing audit; Electronization; Preoperative preparation; Preoperative checklist

Internal Audit of Compliance with a Perioperative Checklist in a Tertiary Care Neurosurgical Unit.

In 1999, the Institute of Medicine reported that, in the United States, 44,000 to 98,000 people die annually as a result of avoidable medical errors. Among the many initiatives undertaken to stem avoidable surgical errors, the World Health Organization (WHO) Surgical Safety Checklist has certainly been one of the most successful. Many surgical units have implemented adapted versions of the WHO Surgical Safety Checklist, audited their performance and discussed issues relating to the implementation process. However, such literature is still lacking in neurosurgery. A prospective observational study of 171 neurosurgical cases was conducted over an 8-week period. An independent observer assessed compliance with and completeness of the three steps in the perioperative checklist: Sign-in, Time-out and Sign-out. Factors that may reduce compliance were also analyzed. Compliance with the Sign-in, Time-out and Sign-out steps was 82%, 99% and 93% respectively. On average, 92% of the Time-out elements were verified. The emergent nature of a surgery was the only factor that caused a statistically significant reduction in compliance with the checklist. Overall compliance diminished during the observation period. In this internal audit study, compliance with the preoperative checklist reached a satisfactory level. Further work is still needed, however, on some aspects of our surgical strategy, namely, a relatively low compliance rate with the Sign-in process was recorded and emergent cases were associated with decreased performance.

Abstract: Implementation of Pre-Operative Checklist: An Effort to Reduce Delays in Surgery and to Improve Patient Safety

Background: A quality improvement project conducted at a teaching hospital in Rwanda in October 2013, showed the operating theatres were underutilized, with delayed surgery start times and prolonged turnover. One factor contributing to these delays was the inadequate preparation of patients prior to transfer to the theatre department. Description: Multidisciplinary stakeholders from the departments of anesthesia, surgery and nursing provided valuable insight to develop a pre-operative checklist to ensure that patients were prepared for surgery and to minimize disruptions to patient flow. Both the World Health Organization surgical safety guidelines and safety checks within the Joint Commission’s universal protocol, such as surgical site marking, were reviewed and incorporated into the checklist. The checklist was implemented in December 2013 and a corresponding policy was also developed and implemented. Education regarding the completion of the checklist and its importance was conducted both in the theatre and in departments that frequently transfer patients to the theatre. A retrospective documentation audit was conducted in May 2014, showing 59% compliance in completing the checklist. Since the audit, further education has been provided to staff in attempts to increase the compliance rate. Lesson Learned: Successful implementation was dependent on the involvement of a multidisciplinary team, and ongoing education regarding each component of the checklist. The checklist has helped to standardize perioperative care delivery, and improve overall interdisciplinary communication. Conclusion: Patient safety should be a top priority of every operating theatre. Implementation of a standardized preoperative checklist at CHUK has shown to be an innovative tool for improving patient preparation, communication and overall efficiency in the operating room. Keywords: preoperative checklist, operating theatre, patient safety, multidisciplinary collaboration

A checklist for endonasal transsphenoidal anterior skull base surgery.

OBJECT 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 checklist for endonasal transsphenoidal anterior skull base surgery was developed to help safeguard patients, improve outcomes, and enhance teambuilding.

Avoidance of serious medical errors in refractive surgery using a custom preoperative checklist

To implement and measure the effect of a surgical safety checklist on the prevention of serious medical errors (never-events). Boston Eye Group, Boston, Massachusetts, USA. Retrospective cohort study. A safety checklist incorporating 28 sources of error was designed and implemented in December 2011 at the Boston Eye Group's refractive surgical center. Consecutive patients who had primary or enhancement laser vision correction (LVC) between July 2009 and February 2014 were included in this study. Before that date, a general checklist fashioned around the World Health Organization time-out procedure was used. The latter subjects were recruited as controls. The perioperative characteristics of both groups were retrospectively compared. The study comprised 2951 consecutive patients who had primary or enhancement LVC between July 2009 and February 2014; of these, 1417 patients (2744 eyes) had LVC after the implementation of a presurgical safety checklist. The general checklist fashioned around the World Health Organization time-out procedure was used for 1534 patients (2969 eyes). Both groups were comparable in patient age. The most common surgical procedures were laser in situ keratomileusis (78%) and laser-assisted subepithelial keratectomy with mitomycin-C (16%). Although there were 2 (0.07%) serious errors in the prechecklist cohort, none occurred following implementation of the safety checklist protocol (P = .23). The medical errors involved wrong refractive aim in 1 patient and wrong person-wrong procedure-wrong aim in another. Multiple potential sources of error exist in refractive surgery. The broad-scale implementation of a detailed presurgical safety checklist was helpful in minimizing and preventing serious errors (never-events) during LVC. Drs. Shapiro and Urman are members of the Institute for Safety in Office-Based Surgery, a nonprofit organization whose aims are to implement safety checklists for office-based surgery. No author has a financial or proprietary interest in any material or method mentioned.

Coordination of care in hospitals: A rapid review of the literature

PProject SWIFT (System Wide Integration for Transformation) is a programme of work supported by developments in technology, that aims to improve the health of people in Counties Manukau through initiatives focused on community-based care and improving hospital systems. A “rapid review” of literature focussing on coordination of care in hospitals was carried out to support this project. Rapid review is a literature review methodology that is “streamlined” by limiting: the number of databases searched, the types of study design included, the languages that articles are written in, the dates when articles were written, and the level of inclusion of “grey” literature. In total, 30 articles were considered in detail for inclusion in this rapid review, with many other articles considered briefly from title or abstract alone. Of the 30 articles, 12 (40%) were ultimately deemed relevant, and included. In total, 112 unique articles contributed to the literature review, if all of the articles considered by three systematic reviews that contributed to this rapid review are included. The review found reasonable evidence that implementation of patient care delivery models focussing on coordination of care and efficiency can contribute to reductions in length of stay for hospital patients. In addition, reasonable evidence was found indicating that that the use of preoperative briefings and surgical safety checklists by operating teams can improve patient safety outcomes. However, it was not possible to draw firm conclusions from many of the other articles that were reviewed: these tended not to describe measurable improvements to patient outcomes or efficiency, and instead focussed on results that were process rather than outcome oriented, subjective, reported improvements that were not compared against any other measure, or were non-significant.