Presentation Authors: Neil J. Kocher*, Amber Schilling, Chris Hollenbeak, Jay D. Raman, Hershey, PA
Introduction: The Joint Commission Universal Protocol aims to increase patient safety by avoiding "never-events" involving the wrong patient, surgical site, or procedure. Recently, additional preoperative requirements at Penn State Health were implemented including attending physician attestation of the H&P and surgical consent at patient bedside on the morning of surgery. We evaluated whether this added safety policy affected institutional operating room performance indicators and reported adverse patient safety events.
Methods: Key operating room performance indicators from Fiscal Years 2017 and 2018 at Penn State Health Milton S. Hershey Medical Center were reviewed. These included total operative case volume, operating room utilization, first case on-time start rate, and average turnover time. Additional attestation requirements for patient H&P and surgical consent by the attending surgeon were implemented at start of Fiscal Year 2018 (July 1st, 2018). All reported perioperative patient safety events during Fiscal Years 2017 and 2018 were reviewed. Each event was classified into 1 of 8 select categories. Two-sample t-test, Fisher's exact test, and chi-square statistical analyses were performed to compare before and after institution of new preoperative attestation requirements.
Results: Total operative case volume was 24,313 cases in Fiscal Year 2018 (FY18) compared to 25,128 cases in Fiscal Year 2017 (FY17) (p=0.006). Operating room utilization was 80% in FY18 from 82% in FY17 (p=0.01). First case on-time start rates was 58% in FY18 versus 78% in FY17 (p-value < 0.0001). The average turnover time between cases was also increased during FY18 (p < 0.0001). There were 555 and 585 reported operating room safety events in FY18 and FY17, respectively. Of these, 68 events (12.3%) in 2018 and 120 events (21%) in 2017 involved the surgical safety checklist. There was a statistically significant difference in the total number of perioperative events (p < 0.0001) and consent-related events (p=0.001) between FY18 and FY17 (Table).
Conclusions: Surgical safety checklists are essential toward minimizing adverse perioperative events. This study highlights a decrease in the number of report patient safety events after implementation of added pre-procedure verifications, but with negative impact on standard metrics of operating room productivity. Further study is necessary to determine if these effects persist over time.