Crisis checklists for the operating room can improve safety and management
Research Activities, March 2012, No. 379
With 234 million surgical operations performed annually worldwide, more than 3 million patients each year can suffer an adverse event in the operating room. Such crises require rapid, coordinated management in stressful, time-critical settings, relying largely on clinicians' knowledge and skill. Failure to adhere to critical steps in management of these crises is common and hazardous to patients. In a study simulating the most common and life-threatening operating room crises, checklist use resulted in a 6-fold reduction in failure to adhere to critical steps in management, suggesting their potential to improve operating room safety. This reduction was achieved using eight different scenarios with two pilot teams.
Checklists are tools that can improve standardization, teamwork, and overall performance in crisis situations. Checklists for routine perioperative use have been shown in multiple studies to substantially reduce death and complications, and are rapidly becoming established as the standard of care.
This project to aid surgical teams and their patients proceeded in two phases: checklist development and pilot testing of the checklists in a high-fidelity anesthesia simulator. The final product contained checklists for 10 crises: air embolism; anaphylaxis; unstable bradycardia; unstable tachycardia; cardiac arrest with no cardiac electrical activity; cardiac arrest with ventricular fibrillation; failed airway; fire; hemorrhage; and malignant hyperthermia, hypotension, and hypoxia.
The researchers defined a set of evidence-based critical, lifesaving processes for each crisis, resulting in a total of 46 key processes across all scenarios considered essential to management of these crises. The participants rated the overall quality of the checklists and scenarios to be higher than average or excellent. This study was supported by the Agency for Healthcare Research and Quality (T32 HS18537).
See "Crisis checklists for the operating room: Development and pilot testing," by John E. Ziewacz, M.D., Alexander F. Arriaga, M.D., Angela M. Bader, M.D., and others in the Journal of the American College of Surgery 213, pp. 212-219, 2011.