• Pamela Kantelhardt, Alf Giese, and Sven R Kantelhardt.
• Department of Neurosurgery, University Medical Centre, Johannes-Gutenberg University, Langenbeckstr. 1, D-55131 Mainz, Germany.
• Int J Qual Health Care. 2016 Sep 1; 28 (4): 529-35.

IssueRecently, quality tools have been promoted to improve patient safety and process efficiency in healthcare. While surgeons primarily focused on surgical issues, like infection rates or implant design, we introduced pre-admission and preoperative checklists in the early 2000s.Initial AssessmentTo assess the efficiency of these tools in a neurosurgical department, we performed a survey of all spinal instrumentation patients operated in 2011 (n = 147). The results revealed several problems.Choice Of SolutionWe consequently redesigned the checklists accompanied by flanking measures, such as written  and online accessible standards. Furthermore, the staff was trained to use the updated quality tools.ImplementationThe measures were implemented in 2012.EvaluationResults were re-evaluated in a second survey in 2013 (n = 162). We found that the use of pre-admission checklists significantly increased from 47 to 96%, while the use of preoperative checklists significantly decreased from 86 to 75%. Within the same period, the quality and completeness of the checklists did, however, increase, so that in 2013, 43% of the patients had a completely processed preoperative checklist, compared to 29% in 2011.Lessons LearnedThe introduction of checklists alone did not in itself guarantee an improved workflow. The introduction must be accompanied by other measures, like written standards and regular training of employees. Otherwise, the positive effect wears off quickly. Nevertheless, we could show that the stringent application of quality tools can induce a sustainable change. Our data further suggest that the clear and traceable delegation of responsibilities is of high importance.© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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