OR equipment failures higher for cardiac surgeries

Equipment failure accounted for more than one in every five errors that occurred in the operating room (OR), according to an analysis published online July 25 in BMJ Quality & Safety. A drilldown into type of operation found total and equipment-related errors were higher for cardiac procedures than for general surgical procedures.

Ruwan A. Weerakkody, PhD, of Imperial College London, and colleagues decided to evaluate errors related to technology, which is playing an increasingly important role in the OR. They suggested that as equipment gets more complex, so might the propensity for errors due to equipment failures.

They searched MEDLINE, EMBASE, HMIC and other sources from 1965 or 1979 to September 2012 to identify studies that offered systematic, quantitative analyses of error or adverse events in the OR. They selected 28 studies that were either prospective, retrospective or reviews of malpractice claims of OR errors.

Weerakkody et al then calculated total error rate per operation, the percentage of total errors due to equipment error and equipment error rate per operation. In studies that included the data, they also looked at error severity, operation type and the use of checklists.

The majority—21—of the studies were prospective with a mix of independent observer (14) and self-reported (seven) structures. Of those, the median reported total error rate per operation was 15.5 and the median proportion of total error due to equipment failure was 23.5 percent.

Data from studies that listed subtypes of equipment error showed configuration and settings were the most frequent type of error followed by lack of availability of equipment and direct malfunctioning/failure. Based on studies that included error severity, 21.2 percent of errors were considered major, and equipment issues were tied to 20.8 percent of all major errors.

Pooled results on specific procedures showed cardiac surgery had higher operation and equipment errors per operation compared with general surgery, at 18.45 vs. 2 and 2.99 vs. 0.79, respectively.

“Of the eight studies which examine the subtypes of equipment error, it is significant that 70 percent of equipment errors are attributable to equipment availability (32 percent) and configuration (38 percent),” they wrote. “This would suggest that a large proportion of equipment-related error might be avoidable by adequate preoperative checks.”

Their analysis of studies that included checklists found a mean decrease of total error rate per procedure of 38.5 percent after the intervention was initiated and a mean drop in the rate of equipment problems of 48.6 percent. Three studies that evaluated use of a checklist with an equipment check showed a mean reduction in equipment errors of 60.7 percent.

“[I]t is clear that equipment problems form a significant proportion of total error occurring in the OR, and that a large proportion of this error is preventable by robust preoperative safety systems.” The authors recommended evaluating and then incorporating a generic preoperative checklist into the current World Health Organization Surgical Safety Checklist.