Utilizing presurgical checklists and protocols in spinal surgery patients: a quality improvement project

Abstract

BACKGROUND: Approximately 900,000 Americans adults underdo spinal surgery annually, with high associated costs, and supporting literature review suggests that implementing standardized preoperative assessments, such as checklists, can improve surgical outcomes and patient safety, especially for patients with higher risk factors such as elevated BMI and A1c levels, anemia, tobacco use, and undocumented social determinants of health. LOCAL PROBLEM: An outpatient setting in Southeast Montana currently lacks a standardized preoperative assessment tool for elective spinal surgery patients. The clinic relies on a generalized adult pre-anesthesia protocol, which does not address the specific needs of neurosurgical cases. This identified gap potentially impacts patient outcomes and safety. METHODS: To identify and reduce risk factors, a presurgical checklist was implemented over a 6-week period utilizing, Plan-Do-Study-Act cycles in three-week intervals, a total of two cycles were completed, with weekly staff check-ins. INTERVENTION: A modified presurgical spinal checklist was initiated utilizing a .dotphrase in the electronic health record, helping identify surgical risk factors prior to surgery. RESULTS: The project aims were partially met- 80% of .dotphrase utilization was achieved, but only an average checklist completion of 44% was achieved by the final week. The overall .dotphrase utilization for the whole intervention period was 21%, and the average checklist completion across the project was 60%. CONCLUSIONS: Despite the implementation of a .dotphrase intervention, the project only partially met its intended goals, with only 80% of the target .dotphrase utilization achieved and a checklist completion rate of just 44% by the final week. Across the entire intervention period, .dotphrase utilization remained at a low 21%, and checklist completion averaged only 60%. These outcomes suggest that the intervention faced significant barriers, which may have been specific to the local clinical environment. As a result, it is difficult to generalize recommendations to other facilities without further investigation into the challenges faced during this quality improvement project. Future interventions should consider a more tailored approach, possibly incorporating further feedback from staff, improved training and communication, or addressing environmental factors that may have influenced engagement and utilization.