Simulation-based trial of surgical-crisis checklists.

Area of Science:

• Medical Simulation
• Patient Safety
• Surgical Crisis Management

Background:

• Operating-room crises are common but challenging to manage.
• Individual clinicians may rarely encounter these critical events.
• A tool to enhance adherence to best practices during crises was evaluated.

Purpose of the Study:

• To evaluate a tool for improving adherence to evidence-based best practices during operating-room crises.
• To assess the impact of crisis checklists on the management of surgical emergencies.

Main Methods:

• Surgical teams participated in simulated operating-room crisis scenarios.
• Teams used crisis checklists for half the scenarios and managed the rest from memory.
• The primary outcome was failure to adhere to critical care processes.

Main Results:

• Checklist use reduced missed critical care steps from 23% to 6% (P<0.001).
• Multivariate analysis confirmed checklists significantly improved adherence (adjusted RR, 0.28; P<0.001).
• 97% of participants desired checklist use during actual crises.

Conclusions:

• Checklist use significantly improved management of operating-room crises in high-fidelity simulation.
• Crisis checklists show potential to enhance the quality of surgical care.
• Evidence supports the implementation of checklists for operating-room emergencies.