Standard written checklists can improve patient safety during a surgical crisis, study says

When doctors, nurses, and other hospital operating room staff follow a written safety checklist to respond when a patient experiences cardiac arrest, severe allergic reaction, bleeding followed by an irregular heartbeat, or other crisis during surgery, they are nearly 75% less likely to miss a critical clinical step, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ).

While the use of checklists is rapidly becoming a standard of surgical care, the impact of using them during a surgical crisis has been largely untested, according to the study published in the Jan. 17 issue of The New England Journal of Medicine.

“We know that checklists work to improve safety during routine surgery,” said AHRQ Director Carolyn M. Clancy, MD. “Now, we have compelling evidence that checklists also can help surgical teams perform better during surgical emergencies.”

For this randomized controlled trial, investigators simulated multiple operating room crises and assessed the ability of 17 operating room teams from three Boston area hospitals — one teaching hospital and two community hospitals — to adhere to life-saving steps for each simulated crisis. In half of the crisis scenarios, operating room teams were provided with evidence-based, written checklists. In the other half of crisis scenarios, the teams worked from memory alone. When a checklist was used during a surgical crisis, teams were able to reduce the chances of missing a life-saving step, such as calling for help within one minute of a patient experiencing abnormal heart rhythm, by nearly 75%, the researchers said.

Examples of simulated surgical emergencies used in the study were air embolism (gas bubbles in the bloodstream), severe allergic reaction, irregular heart rhythms associated with bleeding, or an unexplained drop in blood pressure. Each surgical team consisted of anesthesia staff, operating room nurses, surgical technologists, and a mock surgeon or practicing surgeon.

Hospital staff who participated in the study said the checklists were easy to use, helped them feel more prepared, and that they would use the checklists during actual surgical emergencies. In addition, 97% of participants said they would want checklists to be used for them if a crisis occurred during their own surgery.