Operating room emergency checklists, how important?

黄建宏

OperatingRoom Emergency Checklists, how important?

Operating-roomcrises  are high risk, stressful events that requirerapid and coordinated care in a time-critical setting (1). Duringthe stress of a critical event, the vast majority of clinicians do notimplement all known best practices optimally (2).

Checklists have long been used in other high-riskindustries (e.g., aviation and nuclear power) as a tool to aid performance duringrare and unpredictable critical events. This study(1) used high-fidelity medicalsimulation to test the hypothesis that checklists improved the management ofoperating-room crises. Their study design, results and conclusions weresummarized as follows (1).

Methods:

Participants were recruited.  Teams were consisted of anesthesia staff(attending physicians, residents, and certified registered nurse anesthetists),operating-room nurses, surgical technologists, and a mock surgeon participant.Each team was exposed to a series of simulated intraoperative crises (includingair embolism, anaphylaxis, asystolic cardiac arrest, hemorrhage followed by ventricularfibrillation, malignant hyperthermia, unexplained hypotension and hypoxemiafollowed by unstable bradycardia, and unstable tachycardia). In half thescenarios, randomly chosen, the team had access to a previously developed set of checklists forcrisis events. In the other half, they worked from memory, asin usual care.

Results:

Checklist use during operating-room crisesresulted in nearly a 75% reduction in failure to adhere to critical steps inmanagement (6% of steps missed with checklists available vs. 23% without checklistsavailable, (P<0.001).

Overall, every team had a lower failurerate for adherence to key processes when the crisis checklists were available.

A total of 97% of the participants agreedwith the statement “If I were having an operation and experienced thisintraoperative emergency, I would want the checklist to be used.”

Conclusions:

Checklist use was associated withsignificant improvement in the management of operating-room crises. Thesefindings suggest that checklists for use during operating-room crises have thepotential to improve surgical care.

References:

1. ArriagaAF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ,Pozner CN, Smink DS, Gawande AA. Simulation-based trial of surgical-crisischecklists. NEngl J Med 2013;368:246–53

2. Goldhaber-FiebertSN, Howard SK. Implementing Emergency Manuals: Can Cognitive Aids HelpTranslate Best Practices for Patient Care During Acute Events? Anesth Analg 2013;117:1149–61