Preoperative Checklist Effects on Surgical Resident and Attending Physician Satisfaction

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Abstract

Faculty Advisor:

Amy Boardman, MD

PURPOSE:

Evaluate if a pre-operative checklist and huddle can improve surgeon satisfaction, efficiency, and safety in an academic tertiary referral center.

BACKGROUND:

Aviation has demonstrated the benefits of checklists to improve safety. A pre-operative checklist/huddle is part of the WHO Surgical Safety Protocol but isn’t widely used beyond the surgical timeout. Negative connotations are frequently associated with patient safety protocols. What if they could make surgery go smoother thereby improving surgeon satisfaction? Would this increase the likelihood of adaptation?

METHODS:

A brief (<3 minutes) checklist was developed incorporating patient issues, anesthesia issues, equipment issues, and miscellaneous for the use in surgical suites. Before implementation, a 10 question (scale of 1-10) survey about OR satisfaction was sent to all surgical/anesthesia residents and attending physicians. After a one-month implementation of the checklist, a second similar survey was sent out for comparison. Average case time, number of cases, turn over time, on time starts, and complication rates were also measured before and after implementation. Statistical analysis using student t-test was used for significance.

RESULTS:

32 pre-intervention and 21 post-intervention surveys were received. They showed no improvement in surgeon satisfaction (P=.84) and surgical team dynamics. Average case length was increased by 2 minutes. Number of cases increased by 117/month. Turn over time remained unchanged. On time starts reduced from 52% to 46%. Operating Room variances decreased by 9%.

DISCUSSION:

The use of a pre-operative checklist demonstrated no improvement in surgeon satisfaction. Additionally, it resulted in minimal impact to surgical efficiency and variance rate.

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