CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2018; 10(01): e172-e178
DOI: 10.1055/s-0038-1675838
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Implementation of a Standardized Patient Safety Checklist in Ophthalmic Surgery

Erin A. Boese
1   Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
Paul P. Lee
1   Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
Grant M. Greenberg
2   Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
Richard V. Harrison
3   Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
Jennifer S. Weizer
1   Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Funding The funding for this work is institutional, Heed Ophthalmic Foundation.
Further Information

Publication History

21 August 2018

06 September 2018

Publication Date:
21 November 2018 (online)


Objective To develop and institute a standardized ophthalmology-specific operating room checklist, and to test adherence to the surgical checklist components after implementation.

Design An ophthalmology-specific operative room checklist was developed using recommendations from surgical preoperative checklists from other subspecialties and checklists specific to cataract surgery. This standardized checklist was then implemented into the operating rooms. Operative room staff was trained on its use. Adherence to the checklist was measured prospectively.

Setting Surgical centers at Kellogg Eye Center in Ann Arbor and Livonia, Michigan.

Participants Patients undergoing ophthalmic surgery at the Livonia and Ann Arbor surgical centers.

Main Outcome(s) and Measure(s) The primary outcome measures were surgical team adherence to each category of the operative checklist (preop, prebrief, preanesthesia verification, time-out, intraocular lens measurement/confirmation for cataract cases, debrief). Adherence to the subsections of the operative checklist was measured during three periods over the course of 1 year: baseline, postintervention (after introduction of the checklist in all operating rooms), and postadjustment (after additional training was provided to operating room staff and incentives to collect data were provided to personnel responsible for collecting it).

Results A total of 2,532 surgical cases were included in the analysis. Baseline adherence ranged from 87 to 90% across preop, prebrief, preanesthesia, and time-out verification sections of the operative checklist. After the institution of the intervention and adjustments, adherence to the surgical checklist improved significantly across all areas of the checklist to 97–98% (p < 0.01).

Conclusions and Relevance The development and implementation of an ophthalmology-specific operative room checklist increase adherence to recommended safety checks prior to the start of surgery. To maximize patient safety, the same or similar checklist is recommended for use in all ophthalmology operating rooms.

Meeting Presentation


  • References

  • 1 Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn LT, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System. 2000
  • 2 Haynes AB, Weiser TG, Berry WR. , et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360 (05) 491-499
  • 3 Joint Commission on Accreditation of Healthcare Organizations. Universal protocol for preventing wrong site, wrong procedure, wrong person surgery. Available at: . Accessed January 1, 2018
  • 4 Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Arch Ophthalmol 2007; 125 (11) 1515-1522
  • 5 Loh HP, de Korne DF, Chee SP, Mathur R. Reducing wrong intraocular lens implants in cataract surgery. Int J Health Care Qual Assur 2017; 30 (06) 492-505
  • 6 The World Health Organization. Surgical Safety Checklist 2009 . Available at: www.who.intpatientsafetysafesurgeryenindex.html . Accessed November 16, 2017
  • 7 American Board of Ophthalmology. Maintaining Certification. Available at: . Accessed November 16, 2017
  • 8 American Academy of Ophthalmology. Wrong Site/Wrong IOL Surgery. Available at: . Accessed January 1, 2018
  • 9 Kelly SP, Steeples LR, Smith R, Azuara-Blanco A. Surgical checklist for cataract surgery: progress with the initiative by the Royal College of Ophthalmologists to improve patient safety. Eye (Lond) 2013; 27 (07) 878-882
  • 10 Lum F, Schachat AP. The quest to eliminate “never events”. Ophthalmology 2009; 116 (06) 1021-1022
  • 11 Schein OD, Banta JT, Chen TC, Pritzker S, Schachat AP. Lessons learned: wrong intraocular lens. Ophthalmology 2012; 119 (10) 2059-2064
  • 12 Maruthappu M, Gilbert BJ, El-Harasis MA. , et al. The influence of volume and experience on individual surgical performance: a systematic review. Ann Surg 2015; 261 (04) 642-647