Hundreds of facilities have started to put emergency manuals into place. Here are some of their stories of how they put these tools into practice and benefits they have seen from using them.
Implementing an Emergency Manual in a 300 Bed Hospital
After adopting the WHO surgical checklist in 2009, our anesthesia group inevitably asked ourselves if we could see a role for the other aviation safety tool, emergency checklists. We already had a proliferation of such devices almost cluttering our workspaces- the ACLS algorithms, the Malignant Hyperthermia checklist, the ASA Difficult Airway algorithm, the newly emerging Local Anesthetic Systemic Toxicity (LAST) guidelines, and our own local fire safety plans. A team assembled (including one of the staff who is a licensed pilot) and looked for a way to group these and add some other basic “disaster plans” in a useable format.
Development of OR Crisis Checklists
In collaboration with a multi-disciplinary group of clinicians from the various Harvard teaching hospitals we developed a set of 12 checklists for the most common and life-threatening operating room crises, enhancing usability, and optimizing adherence to critical steps in management. The work was performed under an AHRQ grant, “Development, Validation and Implementation of Customized Checklists for Safe Surgery”. This work lead to two articles, a pilot study in the Journal of the American College of Surgeons, and a randomized controlled study in the New England Journal of Medicine.
Emergency Manual Implementation in 21 Facilities in Northern California
In the past two years Kaiser Permanente, a large integrated healthcare organization, has had an intense focus on surgical care. Many initiatives, such as perioperative infection rates, efficiency and access, and Enhanced Recovery After Surgery (ERAS) initiatives have competed for attention- probably like most hospitals these days. Emergency Manuals have also been on our agenda. Some key points are listed below that are helping us keep these on the front burner along with many other highly useful initiatives. The Kaiser Permanente experience is that we need these.
Implementing in Large Urban Hospital
A multidisciplinary committee that included members from the Departments of Anesthesiology, Surgery and Nursing and Ariadne Labs was formed to adapt the checklist from the New England Journal of Medicine article to Brigham and Women’s. Once they were adapted, there were multiple presentations to the Department of Anesthesiology, a presentation to the nursing staff and presentation to various committees for approval. In September of 2013, we printed the final version of the checklists and placed them in every anesthesia machine. We also got the approval to add a tab and insert the checklists into the electronic medical record.
Low Cost-High Volume Simulation Training for Emergency Manuals
We have been introducing crisis checklists into our OR environment for about ten months. Many, but far from all of our OR staff, have worked with them during team training exercises in our advanced simulation center. This was a potent technique for getting nursing, technician and surgeon staff to embrace these tools. But the sheer volume of personnel meant that it would take several years to offer this experience to all. For this reason, we undertook a low cost-high volume approach. During a regularly scheduled education hour for all departments, we conducted two, parallel exercises to scale the simulation training experience.
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