Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada.
Department of Surgery, McMaster University Medical Centre, Hamilton, ON, Canada.
Int Forum Allergy Rhinol. 2018 Jul;8(7):831-836. doi: 10.1002/alr.22106. Epub 2018 Feb 27.
The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery.
This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method.
Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%).
The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating room setting.
本研究旨在开发和评估一种航空式挑战与反应鼻窦手术专用清单对三级学术医疗中心鼻窦手术中潜在安全和设备问题的影响。次要目标是评估在手术期间、之前和之后使用清单对手术时间的潜在影响。这项倡议旨在与世界卫生组织（WHO）的“标准”手术清单一起使用。虽然内窥镜鼻窦手术通常被认为是一种安全的手术，但仍会发生可避免的并发症和潜在的安全问题。WHO 手术清单并未直接解决某些特定于手术的问题，这些问题对于内窥镜鼻窦手术可能特别重要。
这项前瞻性观察性试点研究监测了清单实施前后的遵守情况，并比较了安全和设备问题的发生情况。共审核了 47 例连续的内窥镜手术；前 8 例无清单，后 39 例有清单。清单是通过评估患者的治疗过程、利用现有文献、专家共识，并最终通过审核案例进行重新评估而编制的。最终的清单是在所有相关利益相关者参与 Delphi 方法的情况下制定的。
在我们的机构实施这种特定的手术清单，使我们能够识别并纠正 35 例潜在不安全、不当或低效的术前设置情况。这些事件包括局部血管收缩剂或注射麻醉剂标签问题（3，7.7%）以及视频监视器的可用性、功能和/或位置（2，5.1%）、内窥镜（6，15.4%）、微动力系统（6，15.4%）、双极电凝（6，15.4%）和吸引器（12，30.8%）。
这种用于内窥镜鼻窦手术的清单的设计和整合有助于提高手术室环境的效率和患者安全性。
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