ILWACO - Surgeons are discovering what kids who play video games have always known - following a map with checkpoints greatly increases precision and accuracy.
In this case, it's a 19-point aviation-style checklist adapted for the operating room that research has shown reduces the risk of death and complications by more than 30 percent, according to an article published last week in the New England Journal of Medicine.
Doctors at Ocean Beach Hospital are among the first in Washington state and the nation to implement this new surgical protocol, said Dr. David Friedman, a general surgeon at the hospital.
"We're a pilot hospital in this program," Friedman said. "While we may be a small, rural community hospital, this is very much big league stuff."
In a year-long, eight-nation study by the World Health Organization that included the University of Washington Medical Center as a test site, more than 7,600 patients undergoing noncardiac surgeries were tracked. The results of the study were so impressive that Washington is one of a handful of states to launch initiatives encouraging the use of standardized surgical checklists in operating rooms.
Patterned after the decades-old aviation preflight checklist, this low-tech, low-cost innovation is designed to free surgical teams to focus on the complex tasks while relegating the simple or rote to what essentially amounts to a cheat sheet.
The Surgical Care Outcomes Assessment Program (SCOAP) is a statewide physician-led quality assurance campaign that pilot-tested their version of the checklist in 15 hospitals before rolling out their program Jan. 15. The goal is to have every operating room in the state using the surgical checklist by year's end.
As a pilot hospital, Ocean Beach is required to incorporate the checklist on every procedure, according to Friedman.
"All the metaphors tend to be aviation-related, which is good because the industry is very focused on safety," said Friedman, "but what's really important is taking a team approach to surgery."
Much like football players gathering in a huddle before running a play, the SCOAP checklist is used at the start of a surgery to cover the basics of the procedure about to take place and who's responsible for what. Team members introduce themselves by name and role, confirm the patient's name and procedure, the expected length of the surgery, equipment to be used, medication to be administered, and discuss any potential problems or concerns.
"Some of this is very obvious, but sometimes it's the obvious that's overlooked," Friedman said. "The checklist reminds you to slow down. People don't want to hear it, but surgeons are usually rushed, they're facing the pressure of limited time. This is a way to slow down, take a time out and make sure it's right."
After the surgery, with the patient still in the room, the surgical team revisits the checklist as part of a debriefing. They confirm all items on the checklist have been covered, all instruments and supply counts are correct, and that any specimens are accurately labeled.
One of the issues the SCOAP advisors had to wrestle with was how to make the checklist generic, but specific enough for all surgeries. "There are 12 things we really want to make sure happen on every surgery," Friedman said, such as monitoring a diabetic patient's blood sugar levels, and making sure body temperature is appropriately maintained during surgery. Simple steps that can have disastrous consequences if overlooked.
Dr. Jessop McDonnell, Ocean Beach Hospital's orthopedic surgeon has been using his own pre-surgery checklist for four years now. He and his staff recently developed an updated version incorporating the SCOAP standards geared toward the specifics of orthopedics.
"What we are trying to do now in the operating room is formalize the many variables that are present," said McDonnell. "Because we are a small hospital the checklist we have developed is tailored to our needs here at Ocean Beach Hospital."
The premise is simple and reinforces a culture of patient safety, according to Friedman, who is on the SCOAP advisory board. "Certain processes determine outcomes," he said. "The goal is to standardize the process and do it the same way every time."
Currently, there are 42 hospitals enrolled or committed to enrolling in SCOAP, according to Rosa Johnson, the SCOAP program director in Seattle.
Ocean Beach is one of the first hospitals to be involved and is already providing information being used throughout the state, she said.