Paivi Helmio

From the Department of Otorhinolaryngology, Faculty of Medicine, University of Helsinki, Finland.

Helsinki 2015.

More than one-half of adverse events in health care are related to surgery. Surgical patient injuries account

for about 80% of patient injuries in otorhinolaryngology (ORL). The World Health Organisation

(WHO) has developed a Surgical Safety Checklist to prevent errors in the operating theatre. Its use has

been shown to reduce complications and mortality. The aims of the present study were to identify errors

that may underlie those patient injuries that occur in operative ORL, to assess the effects of the WHO

checklist on working processes in the operating theatre, including compliance, and to evaluate how it

would fit into the specialty.

Data of the patient injuries that were sustained during treatment by the ORL specialty between the

years 2001 and 2011 were obtained from a search of the Finnish Patient Insurance Centre registry. The

causes of the injuries were analysed, and whether the WHO checklist could have prevented the error

was evaluated. The checklist was implemented in four Finnish hospitals as a pilot in 2009. A prospective

before-versus-after-intervention study was conducted with a questionnaire for OT personnel in these

four hospitals to evaluate the checklist. The checklist was subsequently implemented for regular use in

the operative unit of the Department of Otorhinolaryngology of Helsinki University Central Hospital.

After one-year of use, compliance and user attitudes were analysed by using data obtained from the

operations database and a survey of operative ORL personnel.

In the 10-year study period, 188 patient injuries were associated with operative ORL. A total of 142

(75.5%) of these injuries occurred due to errors that were made in the operating theatre, and in 125

cases (66.5%) a manual error in performing the surgery was the primary cause of the injury. Six injuries

(3.2%) were caused by wrong site surgery. An error had some degree correspondence with a WHO

checklist item for 18 injuries (9.6%) and it was determined that 9 of these injuries (4.8%) could have

been prevented had the checklist been correctly used. The implementation of the checklist enhanced

the communication between the surgical team members, improved verification of the patient’s identity

and of the correct operation site. Checklist compliance was 62.3% during first year of use. It was considered

easy to use and the Safety Attitude Scores of the personnel were found to be on a high level.

All check items on the list were considered important for ORL. However, a more compact checklist for

outpatient surgery was requested.

Patient injuries in ORL were strongly related to surgery. The WHO Surgical Safety Checklist seems

to be a beneficial tool for preventing errors ORL and is highly relevant for the specialty.

Keywords: operative otorhinolaryngology, patient safety, adverse event, patient injury, wrong site surgery,

surgical safety checklist