Effect of an office-based surgical safety system on patient outcomes

OBJECTIVE: To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications. METHODS: We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plastic surgery practice with an already high standard of care. We recorded baseline, prechecklist rates for each checklist item and postoperative adverse outcomes via a retrospective chart review of 219 cases. After an education program and 30-day run-in period, a prospective, post-checklist implementation chart review was initiated (n = 184), with outcome data compared to the baseline. RESULTS: The total number of complications per 100 patients decreased from 15.1 to 2.72 after checklist implementation (P \u3c .0001), for an absolute risk reduction of 12.4. The proportion of patients with one or more complications decreased from 11.9% to 2.72% (P = .0006). Site and side marking increased from 69.9% prechecklist to 97.8% (P \u3c .0001). Medical optimization increased from 90.9% to 99.5% (P \u3c .0001). Emergency medical services (EMS) policy confirmation, case-specific equipment availability, anticipation of estimated blood loss, and verbal confirmation of local anesthetic toxicity precautions increased from 0% to 90.0% (P \u3c .0001), 92.4% (P \u3c .0001), 82.1% (P \u3c .0001), and 91.3% (P \u3c .0001), respectively. Assessment of patient satisfaction increased from 57.1% to 90.8% (P \u3c .0001). CONCLUSIONS: Implementation of a customizable checklist was associated with a reduction in surgical complications in an office-based plastic surgery practice with an already high standard of care