title: Integrating Cerebrospinal Fluid Shunt Quality Checks into the World Health Organization's Safe Surgery Checklist: A Pilot Study.
abstract: BACKGROUND
  Despite efforts for improvement, cerebrospinal fluid (CSF) shunt failure rates remain high. Recent studies have shown promising reductions in failure rates and infection rates with the routine use of perioperative checklists. This study was conducted to pilot test the feasibility and efficacy of integrating specific CSF shunt surgery quality checks into the World Health Organization (WHO) Surgical Safety Checklist.
  
  
  METHODS
  We designed CSF shunt checklist quality items according to a previously established methodology, including solicitation of best practices by a national multidisciplinary expert panel. We examined adherence to key processes before and after implementation as a measure of the efficacy of the integrated checklist. We then surveyed users regarding perceived checklist utility.
  
  
  RESULTS
  Overall adherence to shunt-specific key processes increased from 8.6 (95% confidence interval [CI], 7.9-9.2) to 9.9 (95% CI, 9.3-10.4; P = 0.0070) per 12 items, driven by the infection control items (4.7 [95% CI, 4.1-5.3] to 6.0 [95% CI, 5.4-6.4] per 8 items; P = 0.0056). All of the survey respondents indicated that the checklist was easy to use. The majority stated that it helped them feel better prepared to perform the procedure consistently according to evidence-based practice, and that if they were to adhere to the checklist consistently, their rate of shunt failure would be expected to decrease.
  
  
  CONCLUSIONS
  The integration of specialty-specific checks into the WHO Safe Surgery Checklist improved adherence to quality processes and generally was well accepted in our pilot study. A larger clinical trial is needed to assess whether this approach could improve shunt outcomes.
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Wong
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: William R G
authors.initials: WRG
authors.lastname: Perry
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Greenberg
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Ho
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Liliana C
authors.initials: LC
authors.lastname: Goumnerova
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: abader@partners.org.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bader
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000592:standards* / Q000706:statistics & numerical data; D057189:Checklist / Q000592:standards*; D019544:Equipment Failure Analysis / Q000592:standards; D004869:Equipment Safety / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D038622:Internationality; D061214:Patient Safety / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D018511:Systems Integration; D014944:World Health Organization
keywords: Cerebrospinal fluid shunt; Checklist; Quality improvement; Surgical safety