Surgical technology and operating- room safety failures: a systematic review of quantitative studies Ruwan A Weerakkody, 1,2 Nicholas J Cheshire, 1,2 Celia Riga, 1,2 Rachael Lear, 1 Mohammed S Hamady, 1 Krishna Moorthy, 1 Ara W Darzi, 1 Charles Vincent, 3 Colin D Bicknell 1,2 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/bmjqs- 2012-001778). 1 Department of Surgery and Cancer, Imperial College London, London, UK 2 Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK 3 Clinical Safety Research Unit, Imperial College, London, UK Correspondence to Colin D Bicknell, Vascular Secretaries Office, Praed Street, London W2 1NY, UK; colin.bicknell@imperial.ac.uk Received 20 December 2012 Revised 10 March 2013 Accepted 5 June 2013 To cite: Weerakkody RA, Cheshire NJ, Riga C, et al. BMJ Qual Saf Published Online First: [ please include Day Month Year] doi:10.1136/bmjqs-2012- 001778 ABSTRACT Background Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care. Methods A systematic review of the published literature yielded 19 362 search results relating to errors and adverse events occurring in the OR, from which 124 quantitative error studies were selected for full-text review and 28 were finally selected. Results Median total errors per procedure in independently-observed prospective studies were 15.5, interquartile range (IQR) 2.0–17.8. Failures of equipment/technology accounted for a median 23.5% (IQR 15.0%–34.1%) of total error. The median number of equipment problems per procedure was 0.9 (IQR 0.3–3.6). From eight studies, subdivision of equipment failures was possible into: equipment availability (37.3%), configuration and settings (43.4%) and direct malfunctioning (33.5%). Observed error rates varied widely with study design and with type of operation: those with a greater burden of technology/equipment tended to show higher equipment-related error rates. Checklists (or similar interventions) reduced equipment error by mean 48.6% (and 60.7% in three studies using specific equipment checklists). Conclusions Equipment-related failures form a substantial proportion of all error occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current WHO checklist. INTRODUCTION There can be no doubt that the develop- ment of technology in the operating room (OR) has led to significant improvements in outcome, reducing post- operative patient morbidity and mortality. However, the increasing use of technol- ogy in all surgical specialties may also increase the complexity of the surgical process and may represent an increasing propensity to error from equipment failures. 1 In order to achieve the highest quality of care for patients, we need to strive to develop technology for improving patient outcomes and develop systems and training pathways that allow effective, safe use of specialised equipment. Medical errors affect up to 16% of patients admitted to hospital and account for significant additional morbidity and mortality. 2 3 Approximately one half of these adverse events are attributable to surgical procedures. 45 Failures in equip- ment and technology are a major impli- cated factor in surgical errors and adverse events. Identification and minimisation of equipment-related failure is therefore an important aspect in improving patient safety and the efficiency of the surgical procedure. Moreover, equipment and devices (as opposed to other types of errors, eg, communication, technical, etc) are potentially the most conducive to objective checking and error reduction by means of checklist systems, which have been shown to be effective, not just in preventing error preoperatively, but in highlighting equipment problems, which would otherwise persist in contributing to error from one operation to the next. 6 SYSTEMATIC REVIEW Weerakkody RA, et al. BMJ Qual Saf 2013;0:1–9. doi:10.1136/bmjqs-2012-001778 1 BMJ Quality & Safety Online First, published on 25 July 2013 as 10.1136/bmjqs-2012-001778 Copyright Article author (or their employer) 2013. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on June 1, 2014 - Published by qualitysafety.bmj.com Downloaded from