The proposed study aims to develop, validate, and implement customized checklists for operating room emergencies and specialty operations in order to improve adherence to accepted safety processes and to decrease the likelihood of serious harm. The long term objective is to improve adherence to accepted processes of care by establishing checklists as standard practice in surgery, thereby improving patient safety and outcomes. Widespread adoption of checklists could reasonably be expected to significantly lower major complications and death in the more than 100 million operations performed annually in the United States. The proposed study aims to develop, validate, and implement customized checklists for operating room emergencies and specialty operations in order to improve adherence to accepted safety processes and to decrease the likelihood of serious harm. The long term objective is to improve adherence to accepted processes of care by establishing checklists as standard practice in surgery, thereby improving patient safety and outcomes. Widespread adoption of checklists could reasonably be expected to significantly lower major complications and death in the more than 100 million operations performed annually in the United States. Following the simulator study, the checklists will be implemented in three clinical sites. Sustained use of the checklists will be measured at 6 and 12 months post- implementation by recording the percentage of cases in which a checklist was used for 50 cases in each of the selected specialties. Validation and evaluation of utility of the checklists will occur in real clinical scenarios via survey data of surgical teams in the selected specialties. Surveys will evaluate the perceived utility, ease of use, fit into work- flow, and perceived benefit to patients, among other variables. Changes in safety attitudes at each site will be measured based on responses to the Focused Safety Attitudes Questionnaire before and after implementation of the checklists at the selected sites.

Public Health Relevance

By implementing checklists for operating room emergencies and for a wide array of surgical procedures, our study could have a significant effect on public health. Widespread application of simple checklists for common surgical procedures and emergencies would ensure that important steps in the operation were followed more frequently. This would likely improve patient safety and outcomes significantly by ensuring adherence to accepted practice standards.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS018537-04
Application #
8304116
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Battles, James
Project Start
2009-09-30
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
4
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Arriaga, Alexander F; Bader, Angela M; Wong, Judith M et al. (2013) Simulation-based trial of surgical-crisis checklists. N Engl J Med 368:246-53
Ziewacz, John E; Arriaga, Alexander F; Bader, Angela M et al. (2011) Crisis checklists for the operating room: development and pilot testing. J Am Coll Surg 213:212-217.e10