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Use of the American Academy of Ophthalmology Surgical Checklist and Implant Timeouts: An Online Survey of Connecticut Ophthalmologists

Syed Amal Hussnain, Amy Yuan and Michael Ehrlich

Objective: To characterize operating room practices among ophthalmologists in Connecticut pertaining to the use of the AAO surgical checklist and implant timeouts.
Methods: Ophthalmologists in Connecticut were emailed an anonymous web-based 15-question survey to inquire about their practice settings, knowledge of the AAO checklist, surgical errors, use of surgical checklists and implant timeouts, as well as perceptions about barriers to the use of surgical checklists.
Results: Of the 232 ophthalmologists contacted, 88 responded of which 16 were disqualified, leaving 72 surveys for analysis. The majority of the respondents belonged to private practice (85%) and had been practicing ophthalmology for >20 years (61%). More than 83% were unaware of the AAO sponsored ophthalmic surgical checklist. Approximately a third (36%) reported never using any surgical checklist and only 68% regularly used an implant timeout. At least 25% had one incident of a wrong implant/device or retained surgical item during their careers. Use of checklist was correlated with responder's belief that using a checklist would enhance patient safety (p=0.001) as well as with use of checklists during residency (p=0.02). There was no correlation between use of checklist and adverse events (p=0.26).
Conclusion: Despite proven utility of surgical checklists and implant timeouts in other surgical specialties, their use remains limited among ophthalmologists. Further research establishing effectiveness of surgical checklists and implant timeouts, as well as emphasis on their use during residency training, is needed to encourage wider acceptance among ophthalmologists.