Effect of Surgical Safety Checklist for Refractive Procedures
Narrative Responses:
Purpose
Potential sources of error in refractive surgery were identified and incorporated into a surgical safety checklist. The purpose of this study was to measure the effect of surgical safety checklist implementation in a busy private keratorefractive surgery (KRS) center on the prevention of medical errors.
Methods
A review of the standard pre-operative and intra-operative steps in KRS was undertaken and potential sources of error were identified. A safety checklist incorporating these sources of error was designed and implemented in December 2011 at the Boston Eye Group, a private refractive surgical center. Consecutive patients who underwent KRS before and after the implementation of the safety checklist were identified and their perioperative characteristics were compared retrospectively. The two groups were compared for baseline characteristics, surgical intervention as well as the rate of medical errors or “never-events”.
Results
A total of 4400 consecutive patients who underwent primary or enhancement KRS at the Boston Eye Group between January 2010 and July 2013 were included in this study. Both patient cohorts were comparable for preoperative characteristics including patient age, mean spherical refractive error, mean astigmatism and refractive goal. The most common surgical procedures were LASIK (85%) and PRK (15%). While there were two (0.09%) never-events in the pre-checklist cohort, a 0% error rate was achieved following implementation of the safety checklist protocol.
Conclusion
Multiple potential sources of error exist in refractive surgery. A new surgical safety checklist seems to be effective in minimizing errors and preventing “never-events”.