Research Activities, July 2013
Crisis checklists may substantially reduce the likelihood of critical missed steps in the operating room
Patient Safety and Quality
A study of 106 simulated surgical-crisis scenarios found that use of a crisis checklist resulted in a nearly 75 percent reduction in failure to adhere to critical steps in crisis management. When checklists were used, only 6 percent of critical steps were missed compared to 23 percent of critical steps being missed when checklists were not available.
The simulation scenarios were performed by 17 operating-room teams from 3 hospitals. Each team spent a 6-hour day in a simulated operating room where they were presented with a series of crisis scenarios. These included air embolism, anaphylaxis, asystolic cardiac arrest, hemorrhage followed by ventricular fibrillation, malignant hyperthermia, unexplained hypotension and hypoxemia followed by unstable bradycardia (abnormally slow heart rate), and unstable tachycardia (abnormally fast heart rate).
Failure to effectively manage life-threatening complications in surgical patients has been recognized as the largest source of variation in surgical mortality among hospitals. The use of surgical safety checklists during routine operative care has been associated with significant reductions in morbidity and mortality. However, the effect of crisis checklists during interoperative crises has been largely untested. Since the relative infrequency of surgical crises made a live clinical trial of crisis checklist interventions not feasible, researchers used a high-fidelity medical simulation to facilitate a structured observation of these unpredictable events. After participating in the simulation exercise, 97 percent of the participants agreed that they would want these checklists used if they had an interoperative crisis as a patient.
The researchers concluded that the crisis-checklist intervention has the potential to meaningfully affect clinical practice and surgical outcomes. Their results suggest that hospital and ambulatory surgical centers should consider the implementation of checklists to increase the safety of surgical care. This study was supported by AHRQ (HS18537).
See "Simulation-based trial of surgical-crisis checklists," by Alexander F. Arriaga, M.D., Angela M. Bader, M.D., Judith M. Wong, M.D., and others in the January 17, 2013, New England Journal of Medicine 368(3), pp. 246-253.