April 12, 2012

Electronic checklist helps enhance surgical safety

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Kelly McDaniel R.N., illustrates the “timeout” protocol that care teams use to review essential checklists before beginning a procedure. (photo by John Russell)

Electronic checklist helps enhance surgical safety

A study by Vanderbilt students and faculty researchers, appearing in an upcoming issue of Surgery, measures the effectiveness of a large-display interactive electronic checklist for helping surgical teams meet safety standards.

At the start of each case, on 40-inch monitors in each OR at Vanderbilt, items on a safety checklist turn from red to green as the assembled team checks off that they have the right patient, the right surgical site, the right procedure and so on.

“Our use of the interactive checklist is something that really sets Vanderbilt apart, and it’s a significant advancement in the field of surgical safety,” said the lead author, third-year Vanderbilt University School of Medicine student Rajshri Mainthia, who worked on the study during a recent stint as a National Institutes of Health Research Fellow.

Error rates are reduced when surgical teams consistently use a simple two-step process: mark the skin at the surgical site ahead of the procedure (before anesthesia), then, just prior to the first incision, take a quick timeout to run through a simple safety checklist.

The universal protocol, as the two-step process is called, was mandated for U.S. hospitals in 2004 by the Joint Commission, the health care accreditation authority. Officials at the Joint Commission estimated last year that wrong-site surgery still occurs 40 times a week in U.S. hospitals and clinics.

The timeout to run the checklist takes about 30 seconds. Compliance hinges on clear verbal communication of checklist items.

A month before the July 2010 implementation of the interactive display, Mainthia and two fellow students observed 80 cases, surreptitiously documenting compliance with the checklist.

One month after implementation of the display, another 80 cases were observed, and eight months later another 80 cases.

Team confirmation of patient identity improved from a pre-implementation compliance rate of 51 percent to a nine months post-implementation rate of 99 percent.

Confirmation of the surgical site and side improved from 60 percent to 94 percent.

Confirmation of the procedure to be performed improved from 95 percent to 100 percent.

“Seeing improvement in verbal confirmation of patient, procedure and site was especially exciting. It could be catastrophic if there’s an error involving any of those items,” Mainthia said.

Mean compliance with core timeout items was 50 percent prior to implementation of the interactive display, 82 percent at one month post-implementation, and 86 percent at nine months post-implementation.

For more information, find the study online at the Surgery website.

Leaders for implementation of the universal protocol and the interactive checklist at VUMC were Nancye Feistritzer, MSN, R.N., associate director of Vanderbilt University Hospital, and Shea Polancich, Ph.D., director of patient safety for VUMC.