• Judith M Wong, Perry William R G WRG Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Yelena Greenberg, Allen L Ho, Stuart R Lipsitz, Liliana C Goumnerova, Edward R Laws, William R Berry, Atul A Gawande, and Angela M Bader.
• Ariadne Labs at Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
• World Neurosurg. 2016 Aug 1; 92: 491-498.e3.

BackgroundDespite efforts for improvement, cerebrospinal fluid (CSF) shunt failure rates remain high. Recent studies have shown promising reductions in failure rates and infection rates with the routine use of perioperative checklists. This study was conducted to pilot test the feasibility and efficacy of integrating specific CSF shunt surgery quality checks into the World Health Organization (WHO) Surgical Safety Checklist.MethodsWe designed CSF shunt checklist quality items according to a previously established methodology, including solicitation of best practices by a national multidisciplinary expert panel. We examined adherence to key processes before and after implementation as a measure of the efficacy of the integrated checklist. We then surveyed users regarding perceived checklist utility.ResultsOverall adherence to shunt-specific key processes increased from 8.6 (95% confidence interval [CI], 7.9-9.2) to 9.9 (95% CI, 9.3-10.4; P = 0.0070) per 12 items, driven by the infection control items (4.7 [95% CI, 4.1-5.3] to 6.0 [95% CI, 5.4-6.4] per 8 items; P = 0.0056). All of the survey respondents indicated that the checklist was easy to use. The majority stated that it helped them feel better prepared to perform the procedure consistently according to evidence-based practice, and that if they were to adhere to the checklist consistently, their rate of shunt failure would be expected to decrease.ConclusionsThe integration of specialty-specific checks into the WHO Safe Surgery Checklist improved adherence to quality processes and generally was well accepted in our pilot study. A larger clinical trial is needed to assess whether this approach could improve shunt outcomes.Copyright © 2016 Elsevier Inc. All rights reserved.

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