Checklists in operating rooms improve performance during crises
In an airplane crisis—an engine failure, a fire—pilots pull out a checklist to help with their decision-making. But in an operating room crisis—massive bleeding, a patient's heart stops—surgical teams don't. Given the complexity of judgment and circumstances, standard practice is for teams to use memory alone. In a new study published in the January 17 issue of the New England Journal of Medicine, however, researchers at Ariadne Labs, a joint center for health system innovation at Brigham and Women's Hospital and Harvard School of Public Health, have found that teams using checklists have markedly better safety performance. Specifically, the research shows that clinicians provided with checklists in a novel study using advanced simulation of surgical crises were three-fourths less likely to miss key life-saving steps in care.
With many surgical procedures happening simultaneously and around the clock in a hospital setting, crises in operating rooms occur frequently, however, for individual clinicians, these incidents are rare. These high-risk, stressful events require rapid, coordinated care, and failure to rescue surgical patients who have life-threatening complications is the largest source of differences in rates of surgical death between hospitals. Researchers report that the failure rate for performing life-saving processes of care dropped from 23 percent to 6 percent during simulations when checklists were available.
"For decades, we in surgery have believed that surgical crisis situations are too complex for simple checklists to be helpful. This work shows that assumption is wrong." said Atul Gawande, MD, MPH, senior author of the paper, a surgeon at BWH, professor in Health Policy and Management at HSPH, and director of Ariadne Labs. "Four years ago, we showed that completing a routine checklist before surgery can substantially reduce the likelihood of a major complication. This new work shows that use of a set of carefully crafted checklists during an operating room crisis also has the potential to markedly improve care and safety."
For this work, researchers recruited 17 operating room teams, comprised of anesthesia staff, operating room nurses, surgical technologists, and a mock surgeon participant to participate in 106 simulated surgical crisis scenarios in a simulated operating room at the STRATUS Center for Medical Simulation at Brigham and Women's Hospital. Each team was randomized to manage half of the scenarios with a set of crisis checklists and the remaining scenarios from memory alone.
Researchers found that in addition to reporting a reduction in the failure to adhere to life-saving processes of care during simulations when checklists were available, 97 percent of participants indicated that they would want these checklists used if they experienced an intraoperative crisis as a patient
"Given these findings, Brigham and Women's Hospital has now committed to implementing these checklists to increase the safety of our patients and to evaluate the effect they have on care. I would encourage other hospitals and surgical centers to consider doing the same," Gawande said.
Up-to-date checklists and implementation materials can be found at www.projectcheck.org/crisis.
Researchers note that because the study was performed in a simulated operating room, rather than in actual operating rooms with real patients, it is unclear if adherence would improve in a real world scenario. However, high-fidelity simulation has become increasingly accepted in medicine as a means of training and evaluation, and well-structured simulation testing has been shown to efficiently assess the value of safety protocols in other fields.
Journal reference: New England Journal of Medicine
Provided by Brigham and Women's Hospital
- Surgical checklists save lives Nov 15, 2011 | not rated yet | 0
- Results show surgical safety checklist drops deaths and complications by more than one third Jan 14, 2009 | not rated yet | 0
- Big VA study shows surgery checklist saves lives Oct 19, 2010 | not rated yet | 0
- Communications training, surgical checklist can reduce costly postoperative complications Dec 05, 2012 | not rated yet | 0
- A glimpse into neurosurgical risk prevention and the surgical checklist Nov 01, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
The Durability of Bone: Long Falls
3 hours ago I am doing a paper on the physics in Valve's Portal and got interested in the "Long Fall Boots" that prevent any damage no matter how far you fall. I...
Is energy convertible to matter?
4 hours ago Can we convert energy to matter?
Rotating electron as a dipole is this right?
7 hours ago An electron as shown by the Stern Gerlach experiment behaves like a dipole (albeit only in one of two states). I have been trying to figure out how...
Dipole term in multipole expansion
11 hours ago Hi. I'm having some difficult in understanding something about the dipole term in a multipole expansion. Griffiths writes the expansion as a sum of...
Bubbles in a Pre-Boiling/Boiling pot of water
12 hours ago How is it that bubbles form on the bottom of a surface of a pot of boiling water? I think that there is probably an elementary answer to this...
Assumptions of Griffith's fracture theory
22 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
- More from Physics Forums - Classical Physics
More news stories
Surgeons investigated sexual function in 62 patients, 50 years and older, who had received extensive spinal–pelvic instrumentation for spinal deformity at the University of Virginia Health Center. Based on their results, ...
Surgery 13 hours ago | not rated yet | 0
Physicians at Monash University and The Alfred Hospital in Melbourne, Australia describe the logistic, medical, and societal challenges faced in treating spine trauma in morbidly obese patients. Based on a case series of ...
Surgery 13 hours ago | not rated yet | 0
Arachnoid cysts are a common type of brain lesion that is usually harmless, but with a risk of rupture or bleeding. A new study identifies risk factors for rupture or bleeding in children with "incidentally" detected arachnoid ...
Surgery 13 hours ago | not rated yet | 0
Posterior fossa subdural hematoma (PFSDH) is a serious and rare condition in newborns, generally occurring after difficult deliveries. But with appropriate treatment, there's an excellent chance of good long-term outcomes ...
Surgery May 20, 2013 | not rated yet | 0
Many women in Texas who are found to have an abnormality on routine mammogram or discover a lump in one of their breasts end up having an old-fashioned surgical biopsy to find out whether the breast abnormality is malignant. ...
Surgery May 17, 2013 | not rated yet | 0
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
13 hours ago | 4.2 / 5 (5) | 0 |
(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...
11 hours ago | 4.9 / 5 (9) | 0 |
An experimental sleeping pill from US drug company Merck is effective at helping people fall and stay asleep, according to reviewers at the US Food and Drug Administration, which could soon approve the new drug.
7 hours ago | 3 / 5 (2) | 0
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
8 hours ago | 5 / 5 (3) | 0 |
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
13 hours ago | 4.5 / 5 (6) | 0 |
A drug commonly used to treat depression and anxiety may improve a stress-related heart condition in people with stable coronary heart disease, according to researchers at Duke Medicine.
9 hours ago | 5 / 5 (1) | 0 |