Article
Optimizing check-lists for information transfer at internal interfaces in patients with spinal instrumentation
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Authors
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Pamela Kantelhardt
- Neurochirurgische Klinik, Universitätsmedizin Mainz
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Alf Giese
- Neurochirurgische Klinik, Universitätsmedizin Mainz
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Sven R. Kantelhardt
- Neurochirurgische Klinik, Universitätsmedizin Mainz
| Published: | June 2, 2015 |
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Outline
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Objective: Interfaces between different treatment phases always carry a high intrinsic risk of loss of or incomplete information. The application of check-lists has been shown to increase the safety of information transfer at interfaces in healthcare, such as admission or transfer from units to the OR. We here assessed the application of pre-admission and preoperative check-lists.
Method: In a retrospective data survey including all patients who underwent spinal instrumentation in 2011 (147 patients) we assessed the use of pre-admission and preoperative check-lists. Problematic items were identified and the checklists re-designed accordingly. Following this we re-evaluated the use of the updated check-lists in 2013 including 162 patients. Descriptive statistics were used to assess pre- and post interventional use of checklists.
Results: Information-loss at internal interfaces was found to be a mayor problem, leading to errors, and inefficient use of resources. Existing quality instruments (including pre-admission and a preoperative check-lists) were not or not correctly used. In 2011 the pre-admission check-list was used in 50% of the cases. Besides the item “timely withdrawl of anticoagulants/antidiabetecs” was only filled in 25% of patients. Reasons for this were often missing knowledge about novel and combined prescriptions containing anticoagulating drugs. Following redesign and mandatory training of the check-list and its correct application the application rate could be raised to 94%, with the item “withdrawl of anticoagulants/antidiabetics” now correctly processed in 52%. In 2011 a preoperative check-list was used in 85% of the cases. The list was signed in 28% and completely filled in and signed in 24% of patients. Items frequently left out were “required blood-products”, “hardware”, “navigation” and “timely withdrawl of anticoagulants/antidiabetics”. Missing standardization resp. missing knowledge of existing standards was identified as main reason for this. Redesign and mandatory schooling resulted in a decrease of the application rate to 75%(!), but more complete forms (46% signed and 43% signed and completed).
Conclusions: Check-lists are valuable instruments for the optimization of information transfer at interfaces in healthcare. They have however to be updated frequently and mandatory trainingis required to promote their application in the daily routine.
