A Surgical Checklist for When Things Go Wrong

Summary and Comment |
January 16, 2013

A Surgical Checklist for When Things Go Wrong

  1. Neil H. Winawer, MD, SFHM

A crisis checklist in the operating room can improve surgical care.

  1. Neil H. Winawer, MD, SFHM

Failure to manage life-threatening complications effectively in surgical patients is the largest source of variation for surgical mortality among hospitals. Although using checklists during routine operative care yields substantial benefits in perioperative morbidity and mortality, little data exist on using checklists during intraoperative crises.

Researchers performed a randomized, controlled trial at three institutions (one academic medical center and two community-based hospitals) to examine use of checklists to assist in managing surgical crisis scenarios (i.e., anaphylaxis, malignant hyperthermia, hemorrhage followed by ventricular fibrillation, air embolism, hypotension followed by unstable bradycardia/tachycardia, and asystolic cardiac arrest). Given the unpredictable nature of these events, a simulation protocol was developed to observe 17 operating teams who participated in 106 surgical crisis scenarios. Failure to adhere to life-saving processes was significantly less common during simulations when checklists were available (6% vs. 23%). The difference in outcomes was significant regardless of the institution or type of crisis scenario.

Comment

Although checklists have been embraced by other industries for decades, only now are we seeing the medical community incorporate this important safety practice: Checklists for central line insertion and routine operative care now are common. Will hospitals incorporate intraoperative crisis checklists based on a study that did not involve real patients? Will physicians be able to put their hubris on a shelf and refer to a cognitive aid during an emergency? Perhaps we should look no further than the participants in this study, 97% of whom agreed that, if they were a patient experiencing a crisis in the operating room, they would want the checklist used.

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