Simulation ticks box for checklists in surgical care

By Piriya Mahendra, medwireNews Reporter

The management of operating-room crises could be significantly improved by using checklists, say researchers in the New England Journal of Medicine.

Findings from the high-fidelity simulation study suggest that intraoperative critical-event checklists used during operating-room crises have the potential to improve surgical care, report Atul Gawande (Brigham and Women's Hospital, Boston, Massachusetts, USA) and team.

For the study, 17 operating-room teams participated in 106 simulated surgical-crisis scenarios such as air embolism, cardiac arrest, and hemorrhage. Failure to adhere to life saving processes of care was significantly less common during simulations when checklists were available. Indeed, only 6% of the care process steps were missed when checklists were available compared with 23% when they were not.

Multivariate analysis that accounted for clustering within teams, and adjusted for institution, scenario, and learning and fatigue effects also showed that failure to adhere to care processes was less common with a checklist, at a relative risk of 0.28.

The researchers note that each team performed better when the crisis checklists were available than when they were not.

Overall, 97% of participants reported that if one of these crises occurred while they were not undergoing an operation, they would want the checklist used.

The checklists were provided as booklets adjacent to the anesthesia machine and adjacent to the circulating nurse's work area.

"In a setting where time-sensitive and appropriate care is essential, this intervention has the potential to meaningfully affect clinical practice and surgical outcomes," write the authors.

"Our study shows a significant and substantial value in the use of carefully designed crisis checklists in the operating room."

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