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Multi-institutional evaluation of a sinus surgery checklist

Authors

  • Zachary M. Soler MD, MSc,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
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  • David A. Poetker MD, MA,

    1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
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  • Luke Rudmik MD,

    1. Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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  • Alkis J. Psaltis MD, PhD,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
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  • John D. Clinger MD,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Jess C. Mace MPH,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Timothy L. Smith MD, MPH

    Corresponding author
    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
    • MD, MPH, Division of Rhinology, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR 97239
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  • J.C.M. and T.L.S. both receive grant funding from the National Institute on Deafness and Other Communication Disorders, one of the National Institutes of Health (Bethesda, MD). T.L.S. is a consultant for IntersectENT (Palo Alto, CA), a position unassociated with any part of this investigation.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To examine the frequency of safe surgical practices specific to endoscopic sinus surgery (ESS) before and after implementation of a checklist at four institutions across North America.

Study Design:

Prospective, multi-institutional, observational study.

Methods:

Consecutive surgeries were observed at four institutions before (n = 100) and after (n = 100) implementation of the ESS Checklist. A passive observer documented whether 10 specific tasks were performed by the surgical team during the course of each case. The frequency with which each item was performed was tabulated, and differences across institutions were evaluated using the Pearson χ2 test. Improvement in the frequency of each single item between pre- and postintervention time periods was assessed by the McNemar χ2 test.

Results:

Successful performance of all 10 tasks in the prechecklist period was not observed for any ESS case at any of the four study sites. As might be expected, performance of any individual task was highly variable, ranging from 14% to 95%. After implementation of the ESS Checklist, successful performance of all 10 tasks during an individual surgery increased from 0% to 87% across all institutions, a change that was highly significant (P < .001). Significant increases in the performance of individual tasks was observed for nine of 10 items across all institutions (P ≤ .031 for all).

Conclusions:

Significant heterogeneity exists with regard to performance of specific tasks aimed at minimizing error during ESS. Utilization of the ESS Checklist standardized practice across four institutions and significantly increased the likelihood that individual safety tasks were performed during the course of sinus surgery. Laryngoscope, 2012

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