In the News
A hospital that performs 10,000 operations in a year will experience, on average, 145 operating room crises in that time. Failure to manage life-threatening complications in surgical patients is the leading cause of variation in surgical mortality in hospitals. Changes in the aviation and nuclear power industries have made the use of checklists during a crisis routine, but when a patient hemorrhages or goes into shock during an operation, a surgical team has no such checklists for guidance.
A team at the Harvard School of Public Health created a series of checklists to improve care during common operating room crises such as anaphylaxis, air embolism, and cardiac arrest. They tested the effectiveness of the checklists by having surgical teams use them during simulations of surgical crises. Seventeen operating room teams, including nurses, anesthesiologists, surgeons, surgical technicians, and residents, participated in 106 simulated surgical-crisis scenarios. Teams were 75% less likely to miss crucial lifesaving steps when guided by checklists than when relying on memory: the rate of failure to perform certain lifesaving processes dropped from 23% to 6% during simulations.
The surgical team members found the checklists easy to use, and the checklists helped them feel better prepared. And 95% of staff members involved in the surgical simulations said they would want these checklists to be used if, as a patient, they experienced an intraoperative crisis.
Checklists covering 12 common operating room crises are available at www.projectcheck.org/crisis. They include information about whom to call for additional help, causes and actions to consider, and potential diagnoses. “Crises are incredibly chaotic, even in simulation. Nurses are often the first to grab the checklist and consult it,” coauthor Atul Gawande told AJN. They also manage critical actions, such as coordinating with the blood bank, calling for a crash cart, or asking for more surgeons and nurses.—Carol Potera
Arriaga AF, et al. N Engl J Med. 2013;368(3):246–53