Multi-institutional evaluation of a sinus surgery checklist.
OBJECTIVE
To examine the frequency of safe surgical practices specific to endoscopic sinus surgery (ESS) before and after implementation of a checklist at four institutions across North America.


METHODS
Prospective, multi-institutional, observational study.


METHODS
Consecutive surgeries were observed at four institutions before (n = 100) and after (n = 100) implementation of the ESS Checklist. A passive observer documented whether 10 specific tasks were performed by the surgical team during the course of each case. The frequency with which each item was performed was tabulated, and differences across institutions were evaluated using the Pearson χ(2) test. Improvement in the frequency of each single item between pre- and postintervention time periods was assessed by the McNemar χ(2) test.


RESULTS
Successful performance of all 10 tasks in the prechecklist period was not observed for any ESS case at any of the four study sites. As might be expected, performance of any individual task was highly variable, ranging from 14% to 95%. After implementation of the ESS Checklist, successful performance of all 10 tasks during an individual surgery increased from 0% to 87% across all institutions, a change that was highly significant (P < .001). Significant increases in the performance of individual tasks was observed for nine of 10 items across all institutions (P ≤ .031 for all).


CONCLUSIONS
Significant heterogeneity exists with regard to performance of specific tasks aimed at minimizing error during ESS. Utilization of the ESS Checklist standardized practice across four institutions and significantly increased the likelihood that individual safety tasks were performed during the course of sinus surgery.
Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Zachary M
ZM
Soler
David A
DA
Poetker
Luke
L
Rudmik
Alkis J
AJ
Psaltis
John D
JD
Clinger
Jess C
JC
Mace
Timothy L
TL
Smith
D057189:Checklist / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D017751:Safety Management / Q000379:methods / Q000458:organization & administration; D012852:Sinusitis / Q000601:surgery*; D013647:Task Performance and Analysis