Impact of a Preoperative Safety Checklist on Perioperative Quality Outcomes and Operative Efficiency

Introduction: Additional preoperative safety checklist requirements at Penn State Health were recently implemented on the morning of surgery. We evaluate whether this added safety policy impacted reported adverse patient safety events and institutional operating room performance indicators. Methods: Key operating room performance indicators from fiscal years 2016 through 2019 quarter 2 were reviewed. Additional attestation requirements by the attending surgeon were implemented at start of fiscal year 2018 (July 1, 2017). All reported perioperative patient safety events during this time were reviewed with events classified into one of 8 select categories. Results: Total operative case volume was 49,894 cases in fiscal years 2016 and 2017, and 36,533 in fiscal years 2018 and 2019 through quarter 2 (p<0.10). Mean operating room use was 81% in both groups (p<0.46). First case on time start rates decreased from 79.5% to 58%, respectively (p<0.0001). Mean turnover time between cases also increased from 35 minutes to 40 minutes, respectively (p<0.0001). There were 252 patient events (0.51%) in fiscal years 2016 and 2017 compared to 94 (0.26%) events in fiscal years 2018 and 2019 through quarter 2 following implementation of the surgical safety checklist (p < 0.0001). The number of incomplete preoperative checklists (39 vs 14, p=0.008) and missing/incomplete patient identification bands (15 vs 2, p=0.004) were also decreased between fiscal years 2016 and 2017, and fiscal years 2018 and 2019 through quarter 2, respectively. Conclusions: A day-of-surgery safety checklist decreased the number of reported patient safety events but with a negative impact on standard metrics of operating room productivity for 18 months following implementation. Further study is necessary to determine if these effects persist over time.