gms | German Medical Science

Objective: Following the introduction of our Postoperative Checklist in 2015, we aimed to evaluate whether the improved performance in postoperative care reported in our initial study had been sustained, and whether we could recommend the Checklist introduction in other neurosurgical units. The World Health Organization Surgical Safety Checklist is notable for its ubiquity and efficacy in improving safety for patients undergoing surgery. However it fails to address pitfalls occurring once the patient has left the operating department, including inadequate clinical assessment, postoperative prescriptions, and documentation of postoperative instructions. In 2015 we introduced a Postoperative Checklist to be completed by the medical team on return to the ward. We observed a dramatic improvement in postoperative care, and the Checklist has been adopted permanently in our department, and introduced in other UK units.

Method: One year following the introduction of our Postoperative Checklist we reviewed the medical records of 50 random patients between September and November 2016. We assessed performance using the original audit matrix which evaluated four principle domains: documentation of procedure; clinical assessment, documentation of postoperative instructions; medical contact details, and compared the quality scores with scores before and immediately after the Checklist was introduced. Ward staff were unaware that performance was being evaluated.

Results: Prior to introduction of the Checklist, postoperative reviews were completed for 74.0% of patients; average score was 34.3%. Following introduction of the Checklist 98.0% underwent postoperative review – the Checklist was used in 77.6% of these cases, average score was 90.6% compared to 62.1% without the Checklist. At re-audit all 50 patients had been reviewed postoperatively; the Checklist was used in all 50 cases, and average score was 95.9%. Performance remained very high across all four domains.

Conclusions: The introduction of a Neurosurgical Postoperative Checklist yielded a dramatic improvement in postoperative clinical assessment, communication of postoperative plans, and postoperative care as a whole. This effect was maintained when re-audited one year later, following the introduction of new junior medical staff. We recommend this Neurosurgical Postoperative Checklist for use in Neurosurgical units as a simple, cheap, reproducible tool to improve patient care