Design and Implementation of a Perioperative Safety Video
Design and Implementation of a Perioperative Safety Video
Object. Surgical and medical errors result from failures in communication and handoffs as well as lack of standardization in clinical protocols and safety practices. Checklists, simulation training, and teamwork training have been shown to decrease adverse patient events and increase the safety culture of surgical teams. The goal of this project was to simplify and standardize perioperative patient safety practices and team communication processes within operative neurosurgery through the creation of an educational safety video targeted at a neurosurgical provider audience.
Methods. A multidisciplinary group consisting of neurosurgeons, anesthesiologists, nurses, neuromonitoring specialists, quality champions, and a professional video production company met over several months in an iterative process to 1) determine the overall objectives of the video, 2) decide on the content and format of the video, 3) modify the proposed content and format based on stakeholder feedback, and 4) record the video and complete final revisions during postproduction.
Results. The video was launched within the authors' institution in July 2012 in conjunction with ongoing research projects to study the effects of the video on 1) multidisciplinary providers' knowledge of perioperative safety practices, 2) provider safety attitudes and safety culture in the operating room, and 3) provider behavior in performing predetermined elements of the preoperative timeout and postoperative debrief.
Conclusions. The neurosurgical perioperative safety video can serve as a national model for how quality champions can drive changes in safety culture and provider behavior among multidisciplinary perioperative patient care teams. Ongoing research is being performed to assess the impact of the video on provider knowledge, behavior, and safety attitudes and culture.
Surgical and medical errors are all too common. The landmark Institute of Medicine book To Err Is Human estimates that 98,000 patients die of complications directly attributable to medical errors every year. In addition, a recent systematic review revealed that 1 in every 150 patients admitted to a hospital dies as a result of an adverse event, and almost two-thirds of in-hospital events are related to surgical care. Other recent studies have elucidated causes of surgical and medical errors, including failures in effective team communication and handoffs as well as lack of standardization in clinical protocols. Despite these factors, promising work has been done in the surgical field to increase patient safety through the use of checklists, simulation training, and teamwork training to increase the quality of teamwork in the operating room. Perhaps one of the strongest endorsements for the use of surgical checklists was demonstrated by the WHO Safe Surgery Saves Lives campaign. The implementation of this standardized, easy-to-use checklist not only has improved perioperative outcomes for morbidity and mortality, but such improvements were also associated with an enhanced perception of teamwork and safety culture among multidisciplinary surgical team members.
Far less in the neurological surgery literature to date has been published that focuses on increasing the neurosurgical safety climate via improved teamwork and communication training as well as standardized clinical care in the form of checklists. The Department of Neurological Surgery at the Mayo Clinic in Arizona recently shared their experience in using an operative checklist to confirm the identity of the patient and the correct procedure, site, and side; verify antibiotic administration; and confirm radiological imaging for the patient. All of these elements are commonly found in the Joint Commission Universal Protocol guidelines. Over a period of 8 years, there was a 99.5% overall compliance in using the operative checklist; however, these investigators were unable to demonstrate a reduction in wrong-patient, wrong-procedure, wrong-site, and wrong-side cases, as none of these events occurred before or after implementation of the checklist. Although no wrong-site or wrong-side surgeries were reported in their study, a recent national survey of neurosurgeons reveals an otherwise troubling trend. Twenty-five percent of surveyed neurosurgeons reported making an incision on the wrong side of the head, and 35% reported wrong-level lumbar surgical procedures during their career. In addition, the operative checklist that was implemented in the Mayo Clinic study did not address any concerns specific to neurological surgery and did not explicitly encourage open communication practices among the multidisciplinary team. Lastly, the implementation of surgical checklists may be met with provider resistance and the perception of less satisfactory levels of team efficiency and comfort.
With these knowledge gaps in mind, we designed a neurosurgical perioperative safety video with the goal of outlining standard critical safety checks and multidisciplinary team communication practices that must occur with every neurosurgical patient in the perioperative setting. The target audience for the video includes neurosurgery and anesthesiology attending physicians and trainees, perioperative and operating room nursing staff, and neuromonitoring specialists. The video is part of a broader organizational initiative to increase the quality and safety of neurosurgical patient care at our institution. We believe it is imperative for neurosurgeons, anesthesiologists, and operating room staff to prioritize patient safety and build a robust culture of safety by elevating safety climate and awareness, especially given the emergence of accountable care organizations, value-based purchasing, pay-for-performance reimbursement schemes, and an overall increasing regulatory focus on reducing adverse events and medical errors.
Abstract and Introduction
Abstract
Object. Surgical and medical errors result from failures in communication and handoffs as well as lack of standardization in clinical protocols and safety practices. Checklists, simulation training, and teamwork training have been shown to decrease adverse patient events and increase the safety culture of surgical teams. The goal of this project was to simplify and standardize perioperative patient safety practices and team communication processes within operative neurosurgery through the creation of an educational safety video targeted at a neurosurgical provider audience.
Methods. A multidisciplinary group consisting of neurosurgeons, anesthesiologists, nurses, neuromonitoring specialists, quality champions, and a professional video production company met over several months in an iterative process to 1) determine the overall objectives of the video, 2) decide on the content and format of the video, 3) modify the proposed content and format based on stakeholder feedback, and 4) record the video and complete final revisions during postproduction.
Results. The video was launched within the authors' institution in July 2012 in conjunction with ongoing research projects to study the effects of the video on 1) multidisciplinary providers' knowledge of perioperative safety practices, 2) provider safety attitudes and safety culture in the operating room, and 3) provider behavior in performing predetermined elements of the preoperative timeout and postoperative debrief.
Conclusions. The neurosurgical perioperative safety video can serve as a national model for how quality champions can drive changes in safety culture and provider behavior among multidisciplinary perioperative patient care teams. Ongoing research is being performed to assess the impact of the video on provider knowledge, behavior, and safety attitudes and culture.
Introduction
Surgical and medical errors are all too common. The landmark Institute of Medicine book To Err Is Human estimates that 98,000 patients die of complications directly attributable to medical errors every year. In addition, a recent systematic review revealed that 1 in every 150 patients admitted to a hospital dies as a result of an adverse event, and almost two-thirds of in-hospital events are related to surgical care. Other recent studies have elucidated causes of surgical and medical errors, including failures in effective team communication and handoffs as well as lack of standardization in clinical protocols. Despite these factors, promising work has been done in the surgical field to increase patient safety through the use of checklists, simulation training, and teamwork training to increase the quality of teamwork in the operating room. Perhaps one of the strongest endorsements for the use of surgical checklists was demonstrated by the WHO Safe Surgery Saves Lives campaign. The implementation of this standardized, easy-to-use checklist not only has improved perioperative outcomes for morbidity and mortality, but such improvements were also associated with an enhanced perception of teamwork and safety culture among multidisciplinary surgical team members.
Far less in the neurological surgery literature to date has been published that focuses on increasing the neurosurgical safety climate via improved teamwork and communication training as well as standardized clinical care in the form of checklists. The Department of Neurological Surgery at the Mayo Clinic in Arizona recently shared their experience in using an operative checklist to confirm the identity of the patient and the correct procedure, site, and side; verify antibiotic administration; and confirm radiological imaging for the patient. All of these elements are commonly found in the Joint Commission Universal Protocol guidelines. Over a period of 8 years, there was a 99.5% overall compliance in using the operative checklist; however, these investigators were unable to demonstrate a reduction in wrong-patient, wrong-procedure, wrong-site, and wrong-side cases, as none of these events occurred before or after implementation of the checklist. Although no wrong-site or wrong-side surgeries were reported in their study, a recent national survey of neurosurgeons reveals an otherwise troubling trend. Twenty-five percent of surveyed neurosurgeons reported making an incision on the wrong side of the head, and 35% reported wrong-level lumbar surgical procedures during their career. In addition, the operative checklist that was implemented in the Mayo Clinic study did not address any concerns specific to neurological surgery and did not explicitly encourage open communication practices among the multidisciplinary team. Lastly, the implementation of surgical checklists may be met with provider resistance and the perception of less satisfactory levels of team efficiency and comfort.
With these knowledge gaps in mind, we designed a neurosurgical perioperative safety video with the goal of outlining standard critical safety checks and multidisciplinary team communication practices that must occur with every neurosurgical patient in the perioperative setting. The target audience for the video includes neurosurgery and anesthesiology attending physicians and trainees, perioperative and operating room nursing staff, and neuromonitoring specialists. The video is part of a broader organizational initiative to increase the quality and safety of neurosurgical patient care at our institution. We believe it is imperative for neurosurgeons, anesthesiologists, and operating room staff to prioritize patient safety and build a robust culture of safety by elevating safety climate and awareness, especially given the emergence of accountable care organizations, value-based purchasing, pay-for-performance reimbursement schemes, and an overall increasing regulatory focus on reducing adverse events and medical errors.
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