Safety and Surgical Checklists Goals and Objectives Care

Safety and Surgical Checklists

Goals and Objectives • Care of Neurosurgical Patient – Pre, Intra, and Post-Operative Checklists • Validated Tools in the Neurosurgical Setting • Environments particular to Neurosurgery – Neuromonitoring – Intra-Operative MRI • Sub-specialty Specific Considerations for Process Quality

Surgical Checklists • Surgical Time Out (WHO and JCAHO) – Prospective Data on 7688 surgical patients – Death 1. 5% to 0. 8%; Complications 11% to 7% • Components – Correct Patient, Procedure, and Surgical Site • Specialty Specific Checklists • Adverse Event Division of Labor – Intra-Procedural Aneurysm Rupture

Checklist Practice Challenges UCLA Prospective Experience • • Cultural Change: Who leads surgical pause? Practice Change: 3 -5 minute completion Standardization of Time Out Potential for Smart Tailored Checklists

Culture of Safety Reporting • • Sources of Errors: Communication Multidisciplinary Team Provider Roles in Timeout and Checklists Berger et al. Safety Reporting Video

Aviation Incidence Guide • Human Factor Analysis • Track, Analyze, Categorize Near Misses – Severity and Duration • Ferroli et al. (14 near misses) – Human Factors (9/14) – Technology (1/14) – Organizational Factors (3/14) – Procedural Factors (1/14)

Near Miss Factor Analysis • Human Factors – Omission, Lack of Communication, Late Detection – Multitasking, Teamwork Failure, Time Pressure • Technologies – Equipment Allocation, Instruments, Interface, Data Interpretation • Organizational Factors task allocation/overlap • Procedural Factors (checklist effectiveness)

Surgical Debriefing • • • Systems Based Practice Real-Time Quality Feedback Diversity of Team Member Perspective

Patterns of Adverse Events in Neurosurgery • • • Surgical Technique Perioperative medical management Protocol Use and Adherence Pre-Operative Optimization Technology Communication

Solutions • • • Process and Outcomes Monitoring Regionalization and Subspecialization Guidelines and Protocols Equipment Standardization Surgical Checklists

Sub-Specialty Considerations • Spine – Intra-Operative Neurophysiological Monitoring • Endovascular • Intra-Operative MRI