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Jennifer Weizer, Grant Greenberg, Van Harrison, Taylor Blachley, Paul P Lee; Institutional Quality Improvement for American Board of Ophthalmology Maintenance of Certification. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
There is no widely accepted patient safety checklist recommended for use in ophthalmic surgery in the United States. We developed and implemented a surgical safety checklist which allowed our faculty members to obtain American Board of Ophthalmology (ABO) Part IV Maintenance of Certification (MOC) credit through the University of Michigan’s sponsorship.
Following ABO requirements for institutional MOC credit, our project identified a patient care problem, evaluated baseline performance, and then developed an intervention that was measured for two consecutive plan/do/check/adjust (PDCA) cycles. We developed a surgical checklist (Figure 1), and we measured each operative team’s adherence to its six main components (i.e. pre-op, pre-brief, pre-anesthesia verification, time-out, positive surgeon response to intraocular lens [IOL] where applicable, and debrief) for all ophthalmic surgeries performed at our institution. Data collection began with a 1-week baseline period prior to utilizing the checklist, followed by two months of post-intervention data collection after the checklist was posted in each operating room and the surgical teams were reminded to use it. The results were then shared with the operative teams, and subsequent post-adjustment adherence data was collected again for two more months to determine if adherence rates changed.
There were 114 surgical cases in the baseline phase, 1135 in the post-intervention phase, and 1283 in the post-adjustment phase. Adherence results for each of the six main checklist components were as follows for the baseline, post-intervention, and post-adjustment phases, respectively, with chi--square tests between phases yielding p-values all <0.05: pre-op 87%, 85%, 97%; pre-brief 90%, 85%, 97%; pre-anesthesia verification 90%, 85%, 97%; time-out 90%, 85%, 97%; positive response to IOL 2%, 86%, 98%; debrief 90%, 71%, 82%.
Through implementation of a surgical checklist, we achieved improved adherence to its six main components, thus improving patient safety in the operating room. Projects such as ours can help educate participating physicians and medical team members about quality improvement, while allowing ophthalmologists to maintain their certification in a way that captures the essence of medical competency.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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