Pre-induction checklists and discomfort in patients. An observational study

BACKGROUND Since the WHO release of the Safe Surgery Saves Lives Program in 2008, peri-operative checklists minimise errors and improve patient safety worldwide. Anaesthesia professionals are often reluctant to use these checklists in front of patients because they fear causing patients' discomfort before anaesthesia and surgery. OBJECTIVE To assess and compare the subjective level of patient discomfort caused by the use of pre-induction checklists with the patient discomfort estimated by anaesthesia providers. DESIGN Prospective observational study. SETTING The current single-centre trial included 110 anaesthesia providers and 125 nonpremedicated ear, nose and throat or maxillofacial surgery patients in Switzerland from June to August 2016. Inclusion criterion: signed general research consent. Exclusion criteria: received premedication, less than 18 years old, day-care patients, dementia or other mental illnesses. INTERVENTIONS Anaesthesia healthcare providers and patients before surgery and on the first postoperative day were asked to rate three statements: (1) Anaesthesia providers should use checklists in the presence of the patient. (2) Using a checklist prior to anaesthesia induction causes discomfort for the patient. (3) The use of checklists prior to induction of anaesthesia reduces the risk of errors. MAIN OUTCOME MEASURES All statements were rated on a 100-mm visual analogue scale, where 0 meant no agreement and 100 meant total agreement. RESULTS Patients overwhelmingly agreed that anaesthesia providers should use checklists in front of them. Anaesthesia providers rated the patient discomfort much higher than actually perceived by patients. Both, patients and anaesthesia providers rated the possibility of reducing the risk of errors high. CONCLUSION Patients experience far less discomfort observing the use of pre-induction checklists than anaesthesia providers expect. Patients value the potential safety benefit significantly higher than anaesthesia providers. These results further support the implementation of peri-operative checklists in the operating room environment.