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World Neurosurg. 2016 Aug;92:491-498.e3. doi: 10.1016/j.wneu.2016.06.064. Epub 2016 Jun 25.

Integrating Cerebrospinal Fluid Shunt Quality Checks into the World Health Organization's Safe Surgery Checklist: A Pilot Study.

Author information

1
Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
2
Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
3
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
4
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
5
Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA.
6
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
7
Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
8
Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: abader@partners.org.

Abstract

BACKGROUND:

Despite efforts for improvement, cerebrospinal fluid (CSF) shunt failure rates remain high. Recent studies have shown promising reductions in failure rates and infection rates with the routine use of perioperative checklists. This study was conducted to pilot test the feasibility and efficacy of integrating specific CSF shunt surgery quality checks into the World Health Organization (WHO) Surgical Safety Checklist.

METHODS:

We designed CSF shunt checklist quality items according to a previously established methodology, including solicitation of best practices by a national multidisciplinary expert panel. We examined adherence to key processes before and after implementation as a measure of the efficacy of the integrated checklist. We then surveyed users regarding perceived checklist utility.

RESULTS:

Overall adherence to shunt-specific key processes increased from 8.6 (95% confidence interval [CI], 7.9-9.2) to 9.9 (95% CI, 9.3-10.4; P = 0.0070) per 12 items, driven by the infection control items (4.7 [95% CI, 4.1-5.3] to 6.0 [95% CI, 5.4-6.4] per 8 items; P = 0.0056). All of the survey respondents indicated that the checklist was easy to use. The majority stated that it helped them feel better prepared to perform the procedure consistently according to evidence-based practice, and that if they were to adhere to the checklist consistently, their rate of shunt failure would be expected to decrease.

CONCLUSIONS:

The integration of specialty-specific checks into the WHO Safe Surgery Checklist improved adherence to quality processes and generally was well accepted in our pilot study. A larger clinical trial is needed to assess whether this approach could improve shunt outcomes.

KEYWORDS:

Cerebrospinal fluid shunt; Checklist; Quality improvement; Surgical safety

PMID:
27350301
DOI:
10.1016/j.wneu.2016.06.064
[Indexed for MEDLINE]

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