title: The design, development, and implementation of a checklist for intraoperative neuromonitoring changes.
abstract: OBJECTIVE
  The purpose of this study was to provide an evidence-based algorithm for the design, development, and implementation of a new checklist for the response to an intraoperative neuromonitoring alert during spine surgery.
  
  
  METHODS
  The aviation and surgical literature was surveyed for evidence of successful checklist design, development, and implementation. The limitations of checklists and the barriers to their implementation were reviewed. Based on this review, an algorithm for neurosurgical checklist creation and implementation was developed. Using this algorithm, a multidisciplinary team surveyed the literature for the best practices for how to respond to an intraoperative neuromonitoring alert. All stakeholders then reviewed the evidence and came to consensus regarding items for inclusion in the checklist.
  
  
  RESULTS
  A checklist for responding to an intraoperative neuromonitoring alert was devised. It highlights the specific roles of the anesthesiologist, surgeon, and neuromonitoring personnel and encourages communication between teams. It focuses on the items critical for identifying and correcting reversible causes of neuromonitoring alerts. Following initial design, the checklist draft was reviewed and amended with stakeholder input. The checklist was then evaluated in a small-scale trial and revised based on usability and feasibility.
  
  
  CONCLUSIONS
  The authors have developed an evidence-based algorithm for the design, development, and implementation of checklists in neurosurgery and have used this algorithm to devise a checklist for responding to intraoperative neuromonitoring alerts in spine surgery.
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California 94143-0332, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Ziewacz
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
authors.forename: Valli P
authors.initials: VP
authors.lastname: Mummaneni
authors.forename: Tsung-Hsi
authors.initials: TH
authors.lastname: Tu
authors.forename: Olaolu C
authors.initials: OC
authors.lastname: Akinbo
authors.forename: Russ
authors.initials: R
authors.lastname: Lyon
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
mesh_terms: D000465:Algorithms; D000758:Anesthesia; D057189:Checklist / Q000379:methods* / Q000592:standards; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000592:standards; D009422:Nervous System Diseases / Q000175:diagnosis*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D013116:Spinal Cord / Q000601:surgery; D013131:Spine / Q000601:surgery