Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia
Myron Yaster MD and Barbara K. Burian PhD
I found today’s PAAD, “Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia”1 in the journal Anesthesia and Analgesia. Unfortunately, as an “alta cocker” (an old fart), I could not for the life of me figure out how to download the video. After calling my good friend Dr. Debnath Chatterjee of Open Anesthesia fame, he pointed me to an article by Ortega et al. in Anesthesia & Analgesia which describes an entirely new category of articles that will be published regularly in the journal entitled: “Videos in Clinical Anesthesia.”2 “These peer-reviewed videos and associated materials will integrate images, animation, and sound to teach and review fundamental concepts and advanced skills in anesthesiology, pain management, critical care, and perioperative medicine. They are intended to help students, trainees, and practicing anesthesiologists to learn and refine their clinical and procedural skills.”2
There are 2 ways to access these videos (thank you Dabe!). The simplest and easiest is to go to www.Openanesthesia.org and look for the videos under the VOCASTS tab. Alternatively, and only if you are a member of the IARS and are into pain, you can also log directly into the journal’s website https://journals.lww.com/anesthesia-analgesia/pages/default.aspx. After entering your IARS log in (good luck!), find the yellow banner and the videos can be found under the COLLECTION tab. In the collection tab find “VIDEO IN CLINICAL ANESTHESIA”.
Because videos are so well suited for training and education, I will try to review these articles for the PAAD community as they get published. They are simultaneously available in both English and Spanish. For today’s PAAD, I’ve asked Dr. Barbara Burian to assist. For those of you who don’t know her, Dr. Burian is a Senior Research Psychologist at NASA Ames Research Center and has worked extensively with the Society for Pediatric Anesthesia’s Quality and Safety committee and checklist committees. She was instrumental in the look and feel of SPA’s checklists and the PediCrisis v 2 app. Myron Yaster MD
Featured article
Ortega, R. , Binda, D. & Nozari, A. (2023). Videos in Clinical Anesthesia. Anesthesia & Analgesia, 136 (5), 962-964. doi: 10.1213/ANE.0000000000006414. PMID: 37058735
Original article and video
Gonzalez M, Brook K, Arriaga A, Hayes R, Nozari A, Ortega R. Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia. Anesth Analg. 2023 Dec 1;137(6):1302-1305. doi: 10.1213/ANE.0000000000006572. Epub 2023 Nov 16. PMID: 37973133.
“The educational benefits of videos include the ability to deliver more information per unit of time, simplification of complex material, presentation of concepts using images or animations, and audience immersion3.”2 Further, as discussed in a previous PAAD, current medical school students do not go to classes in person, rather, they learn virtually by viewing their lectures on line and at their own time and pace. Thus, for many of our newer colleagues, video learning is simply how they learn. The videos in this new series, as demonstrated in today’s PAAD are exceptionally well done AND most importantly are peer-reviewed. Unlike other videos and on-line content, they have been vetted, written and produced to minimize inaccuracy and misleading information.
For most of you reading today’s PAAD, there is little, or maybe, nothing new in either the article or the video. However, for residency or fellowship training directors, it may be invaluable as an educational tool at the beginning of each new rotation. For leaders of the OR or procedure areas, it will be invaluable as a yearly review. Today’s video is clear and concise and highlights most of the elements that can make a checklist either successful or a failure.
Some key points: For checklists to be useful, effective, and routinely used, it is imperative that your institution and everyone involved in perioperative care embrace a culture of safety. Fundamental to this is knowing everyone on the team and their roles to encourage open communication. In turn, this facilitates shared “situational awareness” and effective “crew resource management”, particularly during crises.1 “Time out” checklists, such as those used for surgical safety, encourage all team members to voice observations and concerns and ask questions regarding anticipated events. This approach promotes inclusive leadership, which can enhance behaviors that promote patient safety.”1
The video and associated article stress ”closed loop” communication in which “one team member—the sender—verbalizes information and another, the receiver, repeats the information and thereby becomes the sender of feedback, to indicate that the original message has been acknowledged, understood, and, if appropriate, acted on.”1 This style of communication may seem awkward and artificial at first and some complain that checklist use disrupts workflow.4 Though not mentioned in the video or article, workflow disruption by the checklist is intentional—by stopping other work to use the checklist, everyone’s attention is focused on safety critical actions and provides a dedicated time for concerns to be aired and addressed.5
Finally, how one implements a safety checklist is as important as the checklist itself. “Checklists that are poorly designed and implemented, or viewed as perfunctory, are less likely to improve outcomes.”1 Why is this important? “Checklists can increase detection of potential safety hazards and decrease the risk of complications. Importantly, procedural and surgical safety checklists should be integrated into quality-improvement efforts and organizational culture with local customization for successful implementation.”1
The video includes multiple examples of paper checklists being used; you should keep in mind sometimes these checklists are in electronic form, such as the PediCrisis 2.0 app, or even integrated into the electronic health record (EHR) system. Training is essential and we think this video is valuable for both the training, implementation, and use of checklists in your institution. Finally, there is a difference between the different types of procedure checklists (there are two main types) and time out checklists. This video does not make this distinction and these different types of checklists may look and be used differently. To explain this is beyond the scope of today’s PAAD, however, if there is interest let us know and we’ll look for articles on this issue for a deeper dive.
Please take 10 minutes to watch this video and let Myron know what you think. Send your responses and Myron will post your thoughts in the Friday reader response.
References
1. Gonzalez M, Brook K, Arriaga A, Hayes R, Nozari A, Ortega R: Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia. Anesth Analg 2023; 137: 1302-1305
2. Ortega R, Binda D, Nozari A: Videos in Clinical Anesthesia. Anesth Analg 2023; 136: 962-964
3. Hurtubise L, Martin B, Gilliland A, Mahan J: To play or not to play: leveraging video in medical education. J Grad Med Educ 2013; 5: 13-8
4. Kuiper M: Connective Routines: How Medical Professionals Work with Safety Checklists. Professions and Professionalism 2018; 8: e2251
5. Burian BK, Clebone A, Dismukes K, Ruskin KJ: More Than a Tick Box: Medical Checklist Development, Design, and Use. Anesth Analg 2018; 126: 223-232