Validating Surgical-crisis Checklists

Need

During any low frequency, high acuity event, surgical teams must work together in high stress situations to find optimal approaches and solutions to maximize patient outcomes. It was speculated that a decision support tool (i.e., a checklist) might significantly improve outcomes by reminding the surgical team of critical actions that must be taken during an operative emergency

Intervention

The STRATUS team assisted in the development of a series of checklists for 12 of the most common operative emergencies and tested them using a variety of teams in a simulated operating room. This study could not have been conducted scientifically in the real clinical setting because there was no way to predict nor standardize the occurrence of an emergency. STRATUS created high-fidelity simulations and then randomly assigned subjects to manage the emergencies with or without the checklists. Assessment of performance was carried out for both arms of the study.

Impact

The results of this study were published in the in the January 17, 2013, issue of the New England Journal of Medicine. The research found that the group that used the checklist missed 75% fewer recommended critical actions for the cases under examination. This was the first study to be published in the New England Journal of Medicine in which simulation was accepted as a clinical surrogate for research.

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