title: Efficacy of surgical safety checklist: Assessing orthopaedic surgical implant readiness.
abstract: BACKGROUND
  Our institution employs a Surgical Universal Protocol Preoperative Checklist in accordance with World Health Organization guidelines to promote patient safety. It is used in part to evaluate orthopaedic surgical equipment and implant readiness prior to the initiation of each surgical case. Our goal is to measure the preoperative checklist's efficacy in assessing orthopaedic equipment readiness preoperatively and its ability to prevent orthopaedic equipment failures (OEF). Our study focused on orthopaedic surgery cases as they require a large volume of equipment and implants for successful completion. These cases therefore present an appropriate medium to identify potential weakness in our institution's current surgical safety checklist (SSC).
  
  
  METHODS
  Data was collected over a 6 month period of time, broken into 2 distinct periods. The goal during the first 3 months was to observe compliance with the SSC. And during this time, we observed how often the SSC identified an implant or equipment deficiency at the outset of the case. The goal during the second 3 months was to record if orthopaedic surgical equipment issues were occurring that should have been identified by the SSC. During the second 3 months, we continued to utilize the SSC but also added a postsurgical review at the end of each surgical case. The postsurgical review was a one page questionnaire aimed at identifying any orthopaedic equipment failures that had occurred during the surgical case. For the purposes of this study, we defined an intraoperative orthopaedic equipment failure (OEF) as any one of the 6 following categories: (1) surgery delayed due to missing equipment, (2) lack of sterility of equipment, (3) equipment not available, (4) equipment malfunction, and (5) equipment sets incomplete, or (6) additional equipment brought into room necessary for completion of case. The data was collected at a postsurgical review that was performed by the physicians, nurses, and technicians from the surgical team in a nonthreatening manner. We also attempted to quantify the impact that the OEF had upon the surgical case.
  
  
  RESULTS
  During the first 3 months of the study (phase 1), we confirmed that our institutional SSCs were completed for all orthopaedic cases, including the specific questions related to implants and equipment. During phase 1, using the SSC alone, no orthopaedic equipment failures were identified. During phase 2, 33% of the reported surgical cases were identified as having started without essential equipment available or operational (defined as an orthopaedic equipment failure) in the operating room. The most common negative impact upon the surgical case was additional time requirement.
  
  
  CONCLUSIONS
  Our institution's current SSC fails to prevent OEF in our operating rooms. These checklist failures and intraoperative equipment deficiencies have measureable negative patient safety and institutional cost implications.
  
  
  CONCLUSIONS
  While the SSC is an effective tool it cannot be used alone to prepare for orthopaedic surgical cases. In order to improve patient safety and decrease hospital losses, further research is necessary to implement an effective communication network between surgeons, administrators, operating room nursing and sterile processing to eliminate OEF.
  
  
  METHODS
  Level IV.
authors.affiliation: Florida Orthopaedic Associates, 1337 South International Parkway, Suite 1341, Lake Mary, FL 32746, USA. Electronic address: Bgthomasson.touro@gmail.com.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Thomasson
authors.affiliation: Department of Orthopaedic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA.
authors.forename: David
authors.initials: D
authors.lastname: Fuller
authors.affiliation: Department of Orthopaedic Surgery, Pikeville Medical Center, Pikeville, KY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Mansour
authors.affiliation: Department of Orthopaedic Surgery, Cooper University Medical Center, Camden, NJ, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Marburger
authors.affiliation: Division of Pediatric Anesthesiology, Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, NJ, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Pukenas
mesh_terms: D057189:Checklist / Q000592:standards*; D019544:Equipment Failure Analysis; D006801:Humans; D009873:Operating Rooms / Q000592:standards*; D019637:Orthopedic Procedures / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D011184:Postoperative Period; D057234:Preoperative Period; D017064:Process Assessment, Health Care; D011795:Surveys and Questionnaires
keywords: Checklist; Orthopaedic implants; Patient safety