Abstract
Purpose
Surgical complications are common and frequently preventable. The introduction of the WHO Surgical Safety Checklist has improved surgical outcomes. WHO guidelines reduce, but do not prevent errors. Successful arthroplasty surgery requires strict infection control measures. We observed a single surgical team to see if errors caused by operating room personnel were covered by the WHO Checklist.
Method
Two independent observers studied compliance of WHO Checklists and operating room etiquette, for one surgical team. All operating room personnel were observed during thirteen arthroplasties (hips and knees) from induction to recovery. All Personnel were blinded to the purpose of this study. Data was categorised into errors with WHO checklists and operating room etiquette.
Results
120 errors were observed in thirteen cases, none of these errors affected patient outcome and they were all corrected promptly. 113 (94%) were operating room etiquette errors and 7 (6%) were WHO checklist errors. Types of operating room etiquette errors which occurred were 32% laminar flow errors, 27% sterility errors and 20% operating room attire errors.
Eleven arthroplasties were signed off as WHO Checklist compliant and two arthroplasties were observed prior to the introduction of WHO checklists. Despite going through the checklist, in seven of the eleven cases subsequent errors were found which should have been identified during the initial surgical pause: two imaging errors, two implant error and three other patient safety errors.
Conclusion
The majority of errors are breaches of operating room etiquette, all being infection control issues in arthroplasty procedures. Many of these errors are not covered by the WHO Checklists. Standardised teaching of operating room etiquette may reduce these. The development of a specific arthroplasty checklist may optimise patient safety.
