title: Avoidance of serious medical errors in refractive surgery using a custom preoperative checklist.
abstract: OBJECTIVE
  To implement and measure the effect of a surgical safety checklist on the prevention of serious medical errors (never-events).
  
  
  METHODS
  Boston Eye Group, Boston, Massachusetts, USA.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A safety checklist incorporating 28 sources of error was designed and implemented in December 2011 at the Boston Eye Group's refractive surgical center. Consecutive patients who had primary or enhancement laser vision correction (LVC) between July 2009 and February 2014 were included in this study. Before that date, a general checklist fashioned around the World Health Organization time-out procedure was used. The latter subjects were recruited as controls. The perioperative characteristics of both groups were retrospectively compared.
  
  
  RESULTS
  The study comprised 2951 consecutive patients who had primary or enhancement LVC between July 2009 and February 2014; of these, 1417 patients (2744 eyes) had LVC after the implementation of a presurgical safety checklist. The general checklist fashioned around the World Health Organization time-out procedure was used for 1534 patients (2969 eyes). Both groups were comparable in patient age. The most common surgical procedures were laser in situ keratomileusis (78%) and laser-assisted subepithelial keratectomy with mitomycin-C (16%). Although there were 2 (0.07%) serious errors in the prechecklist cohort, none occurred following implementation of the safety checklist protocol (P = .23). The medical errors involved wrong refractive aim in 1 patient and wrong person-wrong procedure-wrong aim in another.
  
  
  CONCLUSIONS
  Multiple potential sources of error exist in refractive surgery. The broad-scale implementation of a detailed presurgical safety checklist was helpful in minimizing and preventing serious errors (never-events) during LVC.
  
  
  BACKGROUND
  Drs. Shapiro and Urman are members of the Institute for Safety in Office-Based Surgery, a nonprofit organization whose aims are to implement safety checklists for office-based surgery. No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Robert
authors.affiliation: From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Choi
authors.affiliation: From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA.
authors.forename: Fred E
authors.initials: FE
authors.lastname: Shapiro
authors.affiliation: From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
authors.affiliation: From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA. Electronic address: samir_melki@meei.harvard.edu.
authors.forename: Samir
authors.initials: S
authors.lastname: Melki
mesh_terms: D000328:Adult; D057189:Checklist / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000592:standards; D020731:Keratomileusis, Laser In Situ / Q000592:standards; D054018:Lasers, Excimer / Q000627:therapeutic use; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D009885:Ophthalmology; D018903:Photorefractive Keratectomy / Q000592:standards; D012189:Retrospective Studies; D017751:Safety Management / Q000379:methods*