Use of equipment whiteboard checklists in improving communication while reducing case cost during ureteroscopy

Effective communication is essential in operating room (OR) settings to reduce interruptions, ensure patient safety, and reduce equipment-related waste. In the setting of percutaneous nephrolithotomy equipment, whiteboards improved OR staff perceptions of communication and decreased procedural costs. Given that ureteroscopy has varying equipment needs from case to case, we sought to evaluate the effectiveness of equipment whiteboard implementation in ureteroscopy.

Thirty-three urology OR staff were recruited to complete questionnaires assessing confidence in equipment accuracy and efficacy of communication both with and without the equipment whiteboard. Furthermore, 50 cases were randomly allocated 1:1 into having the surgeon verbally indicate equipment needs compared to using the whiteboard. These procedures were assessed for objective accuracy of equipment, case length, case cost, and number of interruptions. All outcomes were compared between groups using two-sided T-tests and Fisher's exact tests.

From the questionnaires, we found significant increases with the whiteboard in confidence equipment was in the room (p<0.001, confidence interval [CI] -5.386, -3.621), confidence required equipment was opened (p<0.001, CI -4.956, -3.015), and confidence nothing unnecessary was opened (p<0.001, CI -5.432, -3.393). Furthermore, we found significant improvements in objective equipment accuracy scores (p<0.001, CI -3.982, -1.618), a significant reduction in interruptions (p=0.001, CI -1.147, -0.293), and an average 25% decrease in equipment-related procedural costs (p=0.018, CI 30.661, 313.099).

Implementation of an equipment whiteboard for ureteroscopy was effective for improving OR staff confidence in equipment choices and perceptions of communication. Furthermore, the whiteboard improved equipment accuracy while reducing interruptions and procedural costs.