Patient Safety Checklists: Do They Improve Patient Safety for Supracondylar Humerus Fractures?

BACKGROUND: The purpose of the study was to investigate whether a safety checklist could be used consistently in an academic center, and, whether its presence correlates with a decreased rate of complications, and therefore, improved overall patient safety.

METHODS: Data from 3 years before and after the implementation of the checklist were compared. Prechecklist data from August 2008 through August of 2011, including all operative supracondylar humerus fractures treated at our institution, were retrospectively reviewed. Postchecklist data, from August 2011 to August 2014 were prospectively collected. Patients' charts and their imaging were all reviewed for: fracture type, nerve injury, placement of a medial pin, infection, loss of alignment, loss of fixation, and return to the operating room (OR). Patients who were within the checklist group were reviewed for checklist compliance and concordance of resident and attending-attested checklists.

RESULTS: Nine hundred thirty-one operative supracondylar humerus fractures were reviewed-394 in the prechecklist group and 537 in the postchecklist group. There was no significant difference in fracture type between the prechecklist and postchecklist groups. No significant differences were found between prechecklist and postchecklist patients in regards to loss of fixation, loss of alignment, infection, or nerve injury. In the postchecklist group, the number of medial pins placed was significantly less than in the prechecklist group (P=0.0001), but this was not found to have clinical significance. In the prechecklist group, 11 patients returned to the OR for a second procedure, whereas 4 in the postchecklist group had a return to the OR. This finding was significant (P=0.015), but the returns to the OR were not related to checklist parameters. The checklist compliance of the attending physicians was 85.85% and the residents were compliant 83.11% of the time. There were documented discrepancies between resident and attending checklists in 7.38% of all total checklists.

CONCLUSIONS: Our patient safety checklists are not necessarily affecting patient care in a clinically significant manner. It is important that we validate and refine these specialty-specific checklists before becoming reliant on them.

LEVEL OF EVIDENCE: Level III.