Sinus Surgery Checklist Standardizes Practice and Safety Tasks

How does implementation of an endoscopic sinus surgery (ESS) checklist affect safe surgical practices specific to ESS?

Background: ESS is one of the most common surgical procedures performed by otolaryngologists. A recent review of 62,823 ESS patients indicated a major complication rate of 1 percent. Additionally, rhinology claims represent 70 percent of indemnity compensation for otolaryngology lawsuits. The authors of this study recently developed a surgical checklist specific to ESS with the objective of minimizing avoidable surgical errors.

Study design: Prospective, multi-institutional, observational study.

Setting: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C.; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Alberta, Canada; Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

Synopsis: At four North American institutions, 100 surgeries prior to and 100 surgeries following implementation of an ESS checklist were observed. A passive observer documented whether 10 individual, specific tasks associated with potentially avoidable errors were performed. Prior to implementation of the checklist, proper display of imaging and proper labeling of injectable local anesthetic were commonly performed tasks. The least commonly performed task was discussing the use of a topical vasoconstrictor with the anesthesiologist. Across institutions, the frequency with which notification occurred differed significantly, as did the prevalence of staining vasoconstrictors. Verbal review of anatomic variations occurred in only 29 of 100 cases. Following implementation of the ESS checklist, a number of tasks were performed 100 percent of the time. However, the authors noted that there was no direct evidence that the checklist actually reduced complications.

Bottom line: 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 ESS.

Reference: Soler ZM, Poetker DA, Rudmik L, et al. Multi-institutional evaluation of a sinus surgery checklist. Laryngoscope. 2012;122(10):2132-2136.