News Feature | August 7, 2013

Could A Simple Checklist Save Millions In Malpractice Claims?

Source: Health IT Outcomes
Katie Wike

By Katie Wike, contributing writer

Operating Room

Recently analyzed data of operating room errors reveals one quarter are technological in nature

BMJ Quality & Safety conducted a systematic review of published literature relating to the following premise: “Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care." Among the study’s conclusions was, “Equipment-related failures form a substantial proportion of all errors occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error.”

The study was conducted by a team of researchers led by Colin Bicknell of the Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London. In their review of 28 studies related to technical errors in the OR, they found, “Failures of equipment/technology accounted for a median 23.5 percent of total error.” In addition, most of the problems were caused when the operator did not use the equipment correctly, the machines were faulty, or the equipment was unavailable, and that these technology/equipment issues were the impetus for more than 15 percent of malpractice claims.

BMJ concluded its assessment, “There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current,” World Health Organization Surgical Safety Checklist.

Medical Design Online reiterates BMJ’s suggestion for the use of a checklist prior to surgery. It reports of the 28 studies the group used - whittled down from 19,392 published results related to errors and adverse events occurring in the OR - “Three … reported on the deployment of an equipment/technology checklist before surgery and showed that this could halve the error rate.” They also note, “The authors appreciate that technological advances have improved the chances of survival and quality of life of people undergoing surgery. But they caution: ‘The increasing use of technology in all surgical specialties may also increase the complexity of the surgical process, and may represent an increasing propensity to error from equipment failure.’”

The technological checklist endorsed by BMJ would not only reduce the one in four chance of a technological failure during surgery, it could impact provider’s bottom line as well. reviewed the BMJ analysis as well and reports it “found that technology/equipment issues were involved in an average of 15.5% of malpractice claims.” This number could be reduced if a pre-surgery checklist were put in place.