A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
With the recent expansion of ambulatory surgical centers, the number of outpatient surgical procedures has increased at an exponential rate. Coupled with the rise in volume has been the increasing complexity of procedures and underlying diseases of patients. The convergence of these factors represents a challenging environment for physicians to deliver safe, high-quality and efficient care.
One potential tool to improve patient safety is the surgical safety checklist. The World Health Organization (WHO) has guidelines in place that have dramatically improved surgical safety, including checklists for health care professionals to use prior to anesthetic delivery, before incision and prior to the patient leaving the operating room (OR). While these checklists have been very effective at improving safety, they have historically focused on the health care team. Few checklists have been investigated and developed that feature prominent patient involvement. A pilot study that was conducted utilizing 35 patients and 52 providers revealed that 94 percent of patients and 83 percent of providers found a checklist to be beneficial in the perioperative setting. Patients felt it would improve their medical knowledge, alleviate anxiety and help them prepare for postoperative recovery. Of note, highly-motivated patients have been linked to higher satisfaction scores.
As pioneers and innovators of safety-based protocols in the OR, the anesthesiology specialty is primed to address the future challenges of patient safety in the ambulatory setting. To create a surgical safety checklist that encourages patient participation, the American Society of Anesthesiologists (ASA) is developing a patient checklist that will highlight questions patients should ask medical providers before undergoing an outpatient procedure with the goal of improving patient empowerment and satisfaction, while reducing perioperative complications. The quality of the checklist questions will be assessed though the use of a consensus study. Data will be collected and analyzed to develop a consensus opinion of the medical community and the patient population on the optimal topics for patients to engage their health care providers prior to undergoing an outpatient surgical procedure. Topics patients are encouraged to discuss may include who will be the anesthetic provider, ways to manage chronic medical conditions, facility accreditation, the ideal location for surgery, equipment and protocols for addressing emergency situations, plans for monitoring vital signs and managing post-operative pain, and written instructions to follow after discharge. Patient satisfaction will also be determined with a follow-up survey.
While the initial goal will be to develop a checklist for patients to discuss with their surgeon and physician anesthesiologist prior to surgery, the checklist will also be tested at multi-institutional sites, via survey, highlighting patient satisfaction scores. A later validation study will be conducted using quality metrics (e.g. unanticipated hospital admission, poor pain control, nausea and vomiting, contradictory anesthetic expectations) to assess whether the use of a patient checklist can be effective to decrease complications and improve patient outcomes.
By establishing a patient surgical safety checklist at your institution, health care professionals can further advance safe, high-quality efficient care. Tools that help physicians and patients better optimize safety during anesthesia and surgery should be embraced in light of the current value-based health care environment. Communicating a clear perioperative plan before, during and after surgery is essential, and using a surgical checklist and providing written instructions are more effective than relying on patient memory. As physicians, we understand that patient safety is our number one priority, and we need to challenge ourselves to improve outcomes.
Fred E. Shapiro is an anesthesiologist.
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