Another Call for Checklists in the Operating Room

February 6, 2014

Although operating room (OR) efficiency and patient safety improve when a Surgical Safety Checklist (SSC) is used, OR personnel do not always implement SSCs, mainly due to checklist fatigue or the perception that the extra steps take too much time.

Operating room (OR) efficiency and patient safety improve when hospital staff use a Surgical Safety Checklist (SSC). However, OR personnel do not always implement SSCs, mainly due to checklist fatigue or the perception that the extra steps take too much time.

Concerned about potential barriers to effective checklist use, researchers from Texas A&M University studied the impact of one hospital’s implementation of SSC on OR efficiency. For their study published in a recent issue of The American Journal of Surgery, the authors reviewed all operations at their multispecialty tertiary care hospital for one pre-SSC year and another post-SSC year. Some of the factors they documented included OR time, operation time, first starts on time, same-day cancellations, and disposable equipment cost.

After examining a total of 35,570 operations — where 17,204 occurred before SSC implementation and 18,366 occurred afterwards — the authors found OR time, operation time, first starts on time, and same-day cancellations were similar across both time periods. Of particular note, first-start delays had a ripple effect in reducing operative efficiencies, though fewer first-start delays reduced the rates of subsequent delays, improved the use of OR time, and enhanced patient satisfaction. However, the SCC did not address the 2 most important causes of first-start delays: surgeon arrival time and patient flow.

After the SSC was implemented, the OR’s mean disposable equipment cost was significantly lower at $70 per operation, which saved the OR approximately $1.2 million in one year.

The authors concluded that OR staff who believe SSCs have a negative impact on OR efficiency need to be educated otherwise, as the checklists facilitate improved surgical team communication and result in a reduction in equipment and disposable instrument waste.