Evaluation of the Pediatric Regional Anesthesia Time-Out Checklist: A Simulation Study.

Abstract

Introduction: The Society for Pediatric Anesthesia Quality and Safety Committee developed the Pediatric Regional Anesthesia Time-Out Checklist, consisting of 14 safety items intended to be reviewed by an anesthesia team prior to a regional anesthetic. Primarily, we hypothesized that use of this Checklist would increase the number of safety items performed compared with no checklist, evaluating the usefulness of this tool. Secondarily, we hypothesized that, after checklist training, subjects would show better clinical judgment by electing to perform a regional anesthetic in scenarios in which no programmed error existed and electing to not perform a regional anesthetic in scenarios in which a programmed error did exist.

Methods: Each anesthesia attending/trainee pair participated in 12 different randomized video-recorded medium-fidelity regional anesthesia simulation scenarios, receiving checklist training after half of the scenarios had been completed by each pair. In four of the scenarios, subjects were expected to decline to perform the regional anesthetic because of an error programmed into the scenario. Two errors consisted of a maximum dose of local anesthetic given by the surgeon immediately prior to the planned regional anesthetic and two errors consisted of coagulation issues prior to neuraxial block (1 with a low platelet count and 1 receiving low molecular weight heparin). Scenarios were scored for the number of safety items identified and performed by the subjects. Additionally, the team's choice to perform the regional anesthetic or abort was recorded.

Results: One-hundred and thirty-two scenarios were performed by 22 physicians. A greater number of safety items were completed after training on the Pediatric Regional Anesthesia Time-Out Checklist, for each of 11 individual groups and when data from all groups was pooled, p < 0.001, 95% CI (0.33, 0.41). Overall, 78% of safety items studied were performed after checklist training compared to 41% of safety items performed prior to training. The team's choice to perform or abort the regional anesthetic occurred as expected more often (92% of scenarios) after Checklist training, compared to before checklist training (77% of scenarios), t = 3.41; p = 0.001, 95% CI (0.03, 0.27). Teams chose to perform the regional anesthetic despite a programmed error in three scenarios (0.05%) prior to Checklist training and no scenarios (0%) after Checklist training.

Conclusion: Pediatric Regional Anesthesia Time-Out Checklist training led to an increased number of safety items performed prior to a simulated anesthetic.