Board 269 - Program Innovations Abstract The Effect of Hard Stop Implementation of a Pre-Induction Checklist on Resident Performance During a Simulated Anesthetic (Submission #1296)

Introduction/Background Surgical safety checklists have been shown to reduce patient complications and improve communication in the operating room.1,2 Checklists have also been shown to improve the management of operating room crises in high fidelity simulation studies.3,4 The pre-anesthetic induction period has been identified as a time in which medical errors can occur.5 The Anesthesia Patient Safety Foundation (APSF) has developed a pre-anesthetic induction patient safety (PIPS) checklist.6 Using full environment simulation (FES), we hope to detect a significant reduction in missed steps during the pre-anesthetic set up when using this checklist. All participants in this study will be exposed to the same clinical scenario but one group will experience a “hard stop” in the documentation workflow. We hope to use the Results of this study to validate the simulated environment as an effective and novel way to inform the implementation and further study of patient safety and quality improvement initiatives that may be difficult to clinically test. Methods Using a randomized, controlled, observer-blinded design, we compare performance of anesthesiology residents using the APSF PIPS checklist in completing a thorough pre-anesthetic induction evaluation and setup, to residents with no checklist.6 The study is performed using the METI high-fidelity simulator. The simulated OR is set up to represent a previously used anesthesia machine/cart that has not been set up for a new anesthetic, and is missing the components highlighted in the PIPS checklist. The residents will be called in to provide anesthesia for a case that was booked initially as a case only requiring local anesthesia. The surgeon will create time pressure for the residents to induce anesthesia prematurely in this entirely elective setting. In the experimental group, the electronic medical record will create a “hard stop” in which the APSF PIPS checklist is displayed and must be checked and signed off on before any further documentation of the anesthetic can occur. In the control group, this “hard stop” will not be present in the electronic medical record. The simulation will end when the resident provides any medication to the patient, and missed steps will be recorded at that time. The hypothesis is that the required use of the APSF PIPS checklist prevents missed steps in the pre-anesthetic set up under time pressure in a simulated operating room. Results: Conclusion Our study illustrates the importance of the simulated environment in evaluation of new patient safety and quality improvement initiatives as the specific situations in which such initiatives are likely to increase patient safety can never be ethically or successfully replicated in real life. References 1. Haynes AB, Weiser TG, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491–9. 2. de Vries EN, Prins HA, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010 Nov 11;363(20):1928–37. 3. Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ, Pozner CN, Smink DS, Gawande AA. Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013 Jan 17;368(3):246–53. 4. Neal JM, Hsiung RL, Mulroy MF, et al. ASRA checklist improves trainee performance during a simulated episode of local anesthetic systemic toxicity. Reg Anesth Pain Med. 2012 Jan-Feb;37(1):8–15. 5. Demaria S, Blasius K, Neustein SM: Missed steps in the preanesthetic set-up. Anesthesia and analgesia 2011; 113:84・8/ 6. APSF Survey Helps To Establish Pre-Induction Checklist. (2013). Retrieved from http://www.apsf.org/newsletters/html/2013/spring/02checklist.htm. Disclosures Mylan Specialties.