What is the Value of the SAGES/AORN MIS Checklist? A Multi-Institutional Practical Assessment

Emily Benham, MD1, William Richardson, MD2, Henry Lin, MD3, Jonathan Dort, MD4, Dimitrios Stefanidis, MD, PhD1. 1Carolinas Healthcare System, Charlotte, NC, 2Ochsner Clinic, New Orleans, LA, 3Naval Hospital Camp LeJeune, NC, 4Inova Fairfax Medical Campus, Falls Church, VA

Background: Surgical safety checklists reduce perioperative complications and mortality. Given that minimally invasive surgery (MIS) is dependent on technology and vulnerable to problems introduced by equipment failure, SAGES and AORN have partnered to create a MIS checklist to optimize case flow and minimize errors and frustration. The aim of this project was to evaluate the effectiveness of the SAGES/AORN MIS Surgery Checklist in preventing disruptions that lead to case delays and determine its ease of use.

Methods: After IRB approval, the checklist was implemented across four institutions by members of the SAGES quality, safety, and outcomes committee. The checklist was completed by the operating team during MIS procedures; given potential conflicts with existing preoperative checklists, the MIS checklist could be completed before or after the case. To assess its effectiveness, we recorded how often the checklist identified problems and how frequently each of the 45 checklist items were not completed.  The perceived usefulness (1=not useful, 5=very useful), ease of use (1=very easy, 5=very difficult), and frustration (1=no frustration, 5=extreme frustration) associated with the checklist use were rated on a 5 point Likert scale by the surgeon. We assessed any differences dependent on timing of checklist completion (before or after surgery).  

Results: The checklist was performed during both basic and complex MIS procedures (n=111) with an average duration of 76.1± 59.8 minutes. When used before the procedure (n=36) the checklist identified missing items in 7 cases (19.44%). When used after the procedure (n=58) the checklist identified missing items in 13 cases (22.41%) that caused an average case delay of 3.4± 4.6 minutes. The most frequently missed checklist items included preoperative preference card review (13.5%), verifying readiness of the carbon dioxide insufflator (9.0%), and verifying availability of the Veress needle (3.6%). The checklist took an average 3.9±2.6 minutes to complete with its usefulness rated as 2.3±1.7, ease of use as 1.7±1.2, and frustration as 1.1±1.2. 

Conclusion: The SAGES/AORN MIS checklist identified problems in 23% of total cases that led to preventable delays. The checklist was easy to complete and not frustrating, indicating that preoperative use of the checklist could improve operative flow. This study also identified which checklist items were most useful which may help abbreviate the checklist, minimizing the frustration and time taken to complete it while maximizing its utility. These promising attributes of the SAGES/AORN MIS checklist should be further explored in future larger scale studies. 

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