title: Surgical technology and operating-room safety failures: a systematic review of quantitative studies.
abstract: BACKGROUND
  Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care.
  
  
  METHODS
  A systematic review of the published literature yielded 19 362 search results relating to errors and adverse events occurring in the OR, from which 124 quantitative error studies were selected for full-text review and 28 were finally selected.
  
  
  RESULTS
  Median total errors per procedure in independently-observed prospective studies were 15.5, interquartile range (IQR) 2.0-17.8. Failures of equipment/technology accounted for a median 23.5% (IQR 15.0%-34.1%) of total error. The median number of equipment problems per procedure was 0.9 (IQR 0.3-3.6). From eight studies, subdivision of equipment failures was possible into: equipment availability (37.3%), configuration and settings (43.4%) and direct malfunctioning (33.5%). Observed error rates varied widely with study design and with type of operation: those with a greater burden of technology/equipment tended to show higher equipment-related error rates. Checklists (or similar interventions) reduced equipment error by mean 48.6% (and 60.7% in three studies using specific equipment checklists).
  
  
  CONCLUSIONS
  Equipment-related failures form a substantial proportion of all error occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current WHO checklist.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Ruwan A
authors.initials: RA
authors.lastname: Weerakkody
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Cheshire
authors.forename: Celia
authors.initials: C
authors.lastname: Riga
authors.forename: Rachael
authors.initials: R
authors.lastname: Lear
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: Hamady
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
authors.forename: Colin D
authors.initials: CD
authors.lastname: Bicknell
mesh_terms: D004868:Equipment Failure / Q000706:statistics & numerical data; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D009873:Operating Rooms; D061214:Patient Safety
keywords: Checklists; Healthcare quality improvement; Patient safety; Safety culture; Surgery