A Time-Out Checklist for Pediatric Regional Anesthetics

Although pediatric regional anesthesia has a demonstrated record of safety, adverse events, especially those related to block performance issues, still may occur. To reduce the frequency of those events, we developed a Regional Anesthesia Time-Out Checklist using expert opinion and the Delphi method.

A content development and review was performed by the authors and the Society for Pediatric Anesthesia Quality and Safety Committee. The expert panel was composed of 12 pediatric anesthesiologists, who achieved consensus after 2 rounds of a modified Delphi method. Finally, an author who is an expert in checklist design (B.B.) provided guidance on the formatting and layout of the checklist items to ensure clarity and ease of use. The resulting checklist was trialed in a small pilot study to solicit feedback in a real-life setting.

Sixteen items were included in the checklist sent to the expert panel for the first round of Delphi. Items that had an average rating of 3 or more, with fewer than 3 negative comments, were retained (n = 15). Feedback led to combining several items and dividing the checklist into 2 sections based on the following temporal implementation criteria: "preoperatively" or "immediately before procedure." All remaining 12 checklist items received a positive response from more than 50% of expert panel members and therefore were retained after the second and final round of Delphi. No significant alterations were suggested in the pilot trial.

The Delphi method and human factors principles enabled the creation of a Regional Anesthesia Time-Out Checklist based on published and experiential knowledge of adverse events. Usability of the checklist was supported through the results of a pilot study.