The individual steps of surgical procedures are not routinely timed, monitored, and optimized in the manner that is typically done for critical processes in most industries. This would not be surprising if it were not the case that mortality due to operator error is about a thousand times more likely in the operating room than on a commercial airline flight.  We believe that implementation of checklists for the individual steps of operative procedures could make surgeries safer and could improve quality.

Because checklists for operative steps are currently not routine, we are beginning this journey with a pilot study aimed at assessing feasibility and attitudes towards implementation of such checklists.  We will implement checklists for operative steps of two specific surgical procedures (wide excision with sentinel lymph node biopsy and laparoscopic resection of liver tumor) performed by two surgeons at Duke Hospital over a three-month period.  Before and after the intervention period, we will survey the operating room nursing and anesthesia staff to evaluate the perceived baseline andpost-intervention perception of teamwork, communication, and the utility of operative checklists.

It is imperative that we as surgeons ensure that we carefully monitor and optimize all the steps of the surgeries we perform and that we communicate precisely what is being done at all times during surgical procedures.  Checking and tracking the steps of surgical procedures not only promises to increase the safety and quality of operations, but it could also enhance education and training, provide opportunities for research to improve outcomes in various ways, and reduce costs.  Just like a virtuoso orchestra, none of us will ever be too good to be above reading from the same sheet of music and optimizing communication among members of the team, and every patient deserves the very best performance when it comes to their surgery.