title: Effect of an office-based surgical safety system on patient outcomes.
abstract: OBJECTIVE
  To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications.
  
  
  METHODS
  We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plastic surgery practice with an already high standard of care. We recorded baseline, prechecklist rates for each checklist item and postoperative adverse outcomes via a retrospective chart review of 219 cases. After an education program and 30-day run-in period, a prospective, post-checklist implementation chart review was initiated (n = 184), with outcome data compared to the baseline.
  
  
  RESULTS
  The total number of complications per 100 patients decreased from 15.1 to 2.72 after checklist implementation (P < .0001), for an absolute risk reduction of 12.4. The proportion of patients with one or more complications decreased from 11.9% to 2.72% (P = .0006). Site and side marking increased from 69.9% prechecklist to 97.8% (P < .0001). Medical optimization increased from 90.9% to 99.5% (P < .0001). Emergency medical services (EMS) policy confirmation, case-specific equipment availability, anticipation of estimated blood loss, and verbal confirmation of local anesthetic toxicity precautions increased from 0% to 90.0% (P < .0001), 92.4% (P < .0001), 82.1% (P < .0001), and 91.3% (P < .0001), respectively. Assessment of patient satisfaction increased from 57.1% to 90.8% (P < .0001).
  
  
  CONCLUSIONS
  Implementation of a customizable checklist was associated with a reduction in surgical complications in an office-based plastic surgery practice with an already high standard of care.
authors: University of Massachusetts Memorial Medical Center, Worcester.
authors: Noah M
authors: NM
authors: Rosenberg
authors: Richard D
authors: RD
authors: Urman
authors: Sean
authors: S
authors: Gallagher
authors: John
authors: J
authors: Stenglein
authors: Xiaoxia
authors: X
authors: Liu
authors: Fred E
authors: FE
authors: Shapiro