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even within the same speciality&#44; mean that there are important aspects not included in the WHO generic checklist and whose omission could have a negative impact on the course of the surgical procedure and also pose a risk to patient safety&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the main purposes of the checklist is to highlight aspects already known to practitioners that could&#44; however&#44; be overlooked due to fatigue&#44; stress&#44; etc&#46; They were initially implemented in Intensive Care Units and were quickly adopted by surgical departments&#44; where the above-mentioned risks can lead to greater errors&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">For a significant number of neurosurgical procedures&#44; including those performed on the spine&#44; a series of new sections to be added to the checklist could be proposed&#46; There are important steps not included in the generic checklist that are pertinent to this type of intervention&#46; These procedures&#44; moreover&#44; represent the bulk of the conditions treated in neurosurgery departments&#46; Important steps not included on the checklist form are usually clarified through communication between team members&#46; However&#44; this does not always go according to plan and a lack of effective communication has actually been recognised as one of the main threats to patient safety&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study&#44; thanks to the interdisciplinary collaboration of healthcare professionals from different hospitals&#44; we are putting forward a complementary surgical checklist for spine surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A failure mode and effects analysis &#40;FMEA&#41; were performed in collaboration with expert healthcare professionals working in the neurosurgery operating theatre&#46; This involved neurosurgeons&#44; anaesthetists and qualified nurses with experience in the operating theatre&#46; Healthcare professionals from different centres took part&#58; Hospital Torrec&#225;rdenas de Almer&#237;a&#59; Hospital General Universitario Gregorio Mara&#241;&#243;n&#59; and Complejo Hospitalario de Ja&#233;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the first phase&#44; healthcare professionals responded to an open-ended questionnaire in which they had to propose three to five potentially foreseeable and avoidable threats to spine surgery that could compromise the outcome and which were not included in the generic WHO checklist normally used&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors compiled and ordered each of the suggested threats in the form of potential items to be included in the complementary surgical checklist&#46; 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15 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">3</span><p id="par0080" class="elsevierStylePara elsevierViewall">Need for intraoperative neurophysiological monitoring - minimisation of relaxant drugs &#9633; 13 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">4</span><p id="par0085" class="elsevierStylePara elsevierViewall">Availability of planned implant types and sizes &#9633; 13 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">5</span><p id="par0090" class="elsevierStylePara elsevierViewall">Verification of necessary support points and devices &#9633; 12 POINTS</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Frame - specific table - unrestricted abdomen &#40;prone&#41;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Head &#40;prone&#41;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Legs <ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">6</span><p id="par0110" class="elsevierStylePara elsevierViewall">Confirmation of patient&#39;s MRSA carrier&#47;non-carrier status in instrumented surgery &#9633; 12 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">7</span><p id="par0115" class="elsevierStylePara elsevierViewall">Need for fluoroscopy or other intraoperative imaging procedure &#9633; 12 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">8</span><p id="par0120" class="elsevierStylePara elsevierViewall">Confirmation of the level&#40;s&#41; to be operated on &#9633; 12 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">9</span><p id="par0125" class="elsevierStylePara elsevierViewall">In situ antibiotic administration at the operative site &#9633; 13 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">10</span><p id="par0130" class="elsevierStylePara elsevierViewall">Marking with marker pen on the side to be operated on &#9633; 13 POINTS</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">11</span><p id="par0135" class="elsevierStylePara elsevierViewall">Date of last neuroimaging test and which test it is &#9633; 12 points</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">12</span><p id="par0140" class="elsevierStylePara elsevierViewall">MRI or CT not older than one year &#9633; 13 points</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">13</span><p id="par0145" class="elsevierStylePara elsevierViewall">Updated informed consent &#9633; 11 points</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">14</span><p id="par0150" class="elsevierStylePara elsevierViewall">Check and test the operation of intraoperative radiological imaging equipment &#9633; 11 points</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">15</span><p id="par0155" class="elsevierStylePara elsevierViewall">Verification of the surgical technique to be performed &#9633; 11 points</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">16</span><p id="par0160" class="elsevierStylePara elsevierViewall">Verification of antibiotic prophylaxis &#9633; 11 points</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">17</span><p id="par0165" class="elsevierStylePara elsevierViewall">Identification of anomalies in transitional vertebrae &#9633; 13 points</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">18</span><p id="par0170" class="elsevierStylePara elsevierViewall">Confirmation of closure and final locking of osteosynthesis systems &#9633; 13 points</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">19</span><p id="par0175" class="elsevierStylePara elsevierViewall">Confirmation of correct AP and lateral alignment of osteosynthesis systems &#9633; 12 points</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">20</span><p id="par0180" class="elsevierStylePara elsevierViewall">Estimated surgical time &#9633; 11 points</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">21</span><p id="par0185" class="elsevierStylePara elsevierViewall">Wound infiltration with local anaesthetic at the end of the operation &#9633; 12 points</p></li></ul></p><p id="par0190" class="elsevierStylePara elsevierViewall">Based on this weighting&#44; the authors put together the final configuration of the complementary surgical checklist&#44; including those sections with the highest scores&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The final layout of the complementary checklist is shown below&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Complementary surgical checklist in spine surgery</span><p id="par0200" class="elsevierStylePara elsevierViewall">Step 1&#58; Before entering the operating theatre &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">1</span><p id="par0205" class="elsevierStylePara elsevierViewall">Marking with marker pen on the side to be operated on&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">2</span><p id="par0210" class="elsevierStylePara elsevierViewall">Need for urinary catheterization&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">3</span><p id="par0215" class="elsevierStylePara elsevierViewall">Need for intraoperative neurophysiological monitoring - minimisation of relaxant drugs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">4</span><p id="par0220" class="elsevierStylePara elsevierViewall">Availability of planned implant types and sizes to be used&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">5</span><p id="par0225" class="elsevierStylePara elsevierViewall">Confirmation of patient&#39;s methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;MRSA&#41; carrier&#47;non-carrier status in instrumented surgery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">6</span><p id="par0230" class="elsevierStylePara elsevierViewall">MRI&#47;CT not more than one year old&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">7</span><p id="par0235" class="elsevierStylePara elsevierViewall">Identification of anomalies in transitional vertebrae&#46;</p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">Step 2&#58; Before skin incision<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">1</span><p id="par0245" class="elsevierStylePara elsevierViewall">Marking and verification of the vertebral level to be operated on prior to the operation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">2</span><p id="par0250" class="elsevierStylePara elsevierViewall">Verification of support points and required devices&#46;</p></li></ul></p><p id="par0255" class="elsevierStylePara elsevierViewall">Frame - specific table - unrestricted abdomen &#40;prone&#41;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Head &#40;prone&#41;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Legs</p><p id="par0270" class="elsevierStylePara elsevierViewall">Step 3&#58; Before completion of the procedure<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">1</span><p id="par0275" class="elsevierStylePara elsevierViewall">In situ antibiotic administration at the operative site&#46;</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">2</span><p id="par0280" class="elsevierStylePara elsevierViewall">Confirmation of closure and final locking of osteosynthesis systems&#46;</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">3</span><p id="par0285" class="elsevierStylePara elsevierViewall">Confirmation of correct AP and lateral alignment of osteosynthesis systems&#46;</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">4</span><p id="par0290" class="elsevierStylePara elsevierViewall">Wound infiltration with local anaesthetic at the end of the operation&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0295" class="elsevierStylePara elsevierViewall">The avoidance of complications has always been a central concern in the practice of neurosurgery and spine surgery&#46; The implementation of this philosophy in the purely technical field of the speciality needs to be accompanied by a global effort to promote collective actions that help to achieve a better outcome&#46; Insider knowledge about the surgical processes&#44; in conjunction with the need to encourage continuous improvement through the re-engineering of these processes&#44; following principles such as the &#34;Lean&#34; methodology or the &#34;Kaizen&#34; concept&#44; should drive us to pursue excellence in our day-to-day practice&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">It is striking that most adverse events resulting from surgical interventions are more related to errors occurring before or after the procedure than to technical errors during the intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Such failures could be caused by lack of communication between team members&#44; delayed or failed diagnosis&#44; or delayed or failed treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Gawande et al&#46; described how up to 50&#37; of adverse events arising from healthcare could be preventable&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; it is clear that some errors are unavoidable&#44; but that does not preclude systems being put in place to prevent them&#44; and having protocols in place to mitigate them when they do occur&#46; This will have an impact on both patient safety and the overall efficiency of healthcare systems&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Applying all of the above to the area of spine surgery&#44; characterised by the complexity of many of the processes treated&#44; it is clear how crucial it is to keep complications to an absolute minimum&#46; Spine surgery is also particularly sensitive to the risk of disability and harm resulting from unsafe care&#46; The levels of mortality and disability related to this discipline can be a serious threat to outcomes for the units responsible for treating this type of disorder&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">For effective risk management&#44; healthcare risks need to be identified and analysed in order to develop action plans for patient safety&#46; Risk management has to involve all healthcare professionals with a proactive attitude&#44; and the use of methods that allow problems to be identified&#44; their causes to be understood and actions to be taken to prevent incidents from happening&#46; These actions need to be evaluated periodically in order that&#44; where appropriate&#44; improvements can be made&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">The systemic approach&#44; used for error analysis within high-risk organisations&#44; has been explained by Reason&#39;s Swiss cheese model&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> According to this model&#44; there are different barriers represented&#44; for example&#44; by the organisation&#44; organisational culture&#44; internal communication&#44; change management capacity&#44; complete definition of processes&#44; availability of technology and training of healthcare professionals&#44; which&#44; when aligned one after the other&#44; have the capacity to stop undesirable events from filtering through&#46; However&#44; the barriers&#44; represented as slices of cheese&#44; are not perfect and have defects or holes&#59; the more imperfect they are&#44; the fewer and more fragile the layers or the more holes there are in them&#44; the greater the chance that these holes will line up and the errors will leak through&#44; leading to a safety incident&#46; The model differentiates between what are strictly speaking human failures&#44; also called active failures&#44; and the latent failures present in the system they filter though&#46; The addition of slices or layers of security within the organisation can provide reinforcement to stop the leakage of errors &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0320" class="elsevierStylePara elsevierViewall">Active failures are considered unsafe acts that may originate from professional training deficits&#44; work overload&#44; lack of supervision or other causes&#44; while latent failures have to do with the culture of the institution and are due to organisational and management errors&#44; which are usually long-lasting and difficult to eradicate&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">The creation of reminder systems that prevent compliance being dependent on the memory of individual workers&#44; as well as the review and simplification of processes with the standardisation of routine procedures&#44; the standardisation of more complex working processes and the use of checklists&#44; are all tools aimed at strengthening the structure of the safety system&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">The implementation of the WHO generic checklist is a clear example of this culture&#46; However&#44; we believe that after its standardisation&#44; it is necessary to go a step further in updating and adapting it to more specific procedures&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">The new professionalism in healthcare also makes it necessary to design tools aimed at minimising these incidents&#46; Such tools can range from the acquisition and application of advanced technology in machinery or computational developments&#44; to the enhancement of soft skills closer to nanomanagement&#44; such as effective communication with patients or between healthcare professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0340" class="elsevierStylePara elsevierViewall">The commitment of healthcare organisations to patient safety must therefore be unchallengeable&#46; In order to reduce errors&#44; areas of action should include managing knowledge about aspects related to patient safety&#44; the implementation of training programmes for healthcare professionals aiming to eliminate the &#34;blame culture&#34; and the promotion of patient participation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Initiatives aimed at implementing algorithms closer to soft actions within procedures should also be promoted&#46; The standardisation of the WHO checklist has been considered as such&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">A recent review identified a total of 15 checklists for neurosurgery&#44; of which seven were general&#44; three were for vascular neurosurgery&#44; two for stereotactic and functional neurosurgery&#44; two for spine surgery and one for external ventricular drain placement&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall">Complications are common in spine surgery&#46; In a study of discectomies&#44; the wrong level was exposed at the start of surgery in 15&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In fact&#44; it is estimated that half of all spine surgeons will make at least one spacing error during their career&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> As described in the pioneering experience of Haynes et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Kulkarni et al&#46; found that after implementing the checklist there was a reduction in adverse effects&#44; such as vertebral level error&#44; dural tears&#44; operative site infections and prolongation of hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> For its part&#44; the North American Spine Society had previously proposed a checklist in 2001 with the aim of avoiding space&#44; side and patient errors in spine surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0355" class="elsevierStylePara elsevierViewall">We supplemented the 19 sections of the WHO generic checklist with 13 more in our complementary checklist for spine surgery&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">The current assimilation of hospital operations with industrial processes has led to the generation of standard operating procedures within which sub-processes need to be defined&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> We believe that surgical checklists should be considered at this level&#46; With regard to the issue of adequate compliance&#44; based on effective communication&#44; measures such as internal audits should be considered to ensure compliance with standards and&#44; in the event of deviations&#44; to facilitate change management&#46; The availability in some hospitals of Command Centres within the operating theatre may facilitate these audits&#46; We also consider that the application of these Command Centres&#44; in conjunction with the standardisation of processes&#44; should help to ensure that the effective implementation of complementary checklists can be integrated into a global strategy for patient safety&#46; We also need to assess other aspects that can be addressed thanks to the implementation of these systems&#44; such as the option of generating expense sheets for each surgical procedure linked to specialities and healthcare professionals&#44; and the cross-referencing of these data with outcomes and safety&#46; This would provide highly adjusted analyses of efficiency both per department and per healthcare professional&#46; These aspects are aligned with expected performance in accordance with the values of the new healthcare professionalism&#44; according to which direct collaboration of healthcare professionals in the efficiency of the system must be pursued in order to achieve sustainable&#44; quality and safe healthcare for the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0365" class="elsevierStylePara elsevierViewall">Patient involvement and education in self-care can also reduce complications and improve quality of life after a surgical procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> An obvious example is the marking of the operative site before transferring the patient to the operating theatre&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">The main limitation of our study is that the proposed surgical checklist has not yet been tested in actual practice&#44; so there has not yet been an opportunity to analyse its impact on improving outcomes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0375" class="elsevierStylePara elsevierViewall">The generic WHO checklist does not cover important aspects that are specific to neurosurgical processes&#46; Neurosurgery healthcare professionals have been able to identify a series of practices&#44; specific to the procedures commonly performed during spine surgery&#44; which are not covered by the generic surgical checklist and which&#44; if not properly ensured&#44; may pose a similar threat to those that are included&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">The shortcomings found in the generic surgical checklist can serve as a basis for designing a complementary surgical checklist for procedures performed in spine surgery&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">The implementation of a surgical checklist should be seen as a step forward in the organisational culture related to patient safety&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">There are&#44; however&#44; aspects with their roots in the way organisations function that will determine whether or not the use of checklists is successful and whether or not they are able to serve their purpose&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sources of funding</span><p id="par0395" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0400" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Once the World Health Oraganization &#40;WHO&#41; generic surgical checklist has been standardized and following the itinerary proposed&#44; it is up to the different specialties to continue advancing in the improvement and adjustment of the checklists to their specific procedures&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Through a Failure Mode and Effects Analysis &#40;FMEA&#41; in which professionals from the surgical area of &#8203;&#8203;the Torrec&#225;rdenas University Hospital&#44; Ja&#233;n Hospital Complex and Gregorio Mara&#241;&#243;n General University Hospital participated&#44; aspects that threaten patient safety in spine surgery and that are not included in the WHO generic surgical checklist were proposed&#46; The authors scored each of the proposed items incrementally based on the degree of suitability&#46; Based on the score obtained&#44; they selected those who would be incorporated into the specific safety checklist&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of twenty-one candidate items were proposed to be part of the specific check list&#46; These obtained scores between 15 and 11 points&#46; After scoring them&#44; it was decided to include the thirteen best rated in the definitive surgical checklist&#44; seven of them in the initial phase&#44; two in the phase prior to the incision and another four in the final part of the checklist prior to the completion of the procedure&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Professionals in the surgical area of &#8203;&#8203;Neurosurgery can identify aspects not included in the generic checklist whose non-compliance can affect patient safety in spine surgery to at least the same extent as those included in WHO checklist&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">It is possible to propose a specific complementary checklist for spinal surgery&#44; responsible for collecting aspects related to safety and success in these procedures&#46;</p></span>"
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Clinical Research
Available online 2 September 2024
Proposal for a complementary safety checklist for spine surgery
Propuesta de un listado de verificación quirúrgica complementario para la cirugía de columna vertebral
Antonio José Vargas Lópeza,b,
Corresponding author
ajvargaslopez@hotmail.com

Corresponding author.
, Gador Ramos Bosqueta, Carlos Fernández Carballalc
a Hospital Universitario Torrecárdenas, Almería, Spain
b Hospital Vithas, Almería, Spain
c Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Abstract
Introduction

Once the World Health Oraganization (WHO) generic surgical checklist has been standardized and following the itinerary proposed, it is up to the different specialties to continue advancing in the improvement and adjustment of the checklists to their specific procedures.

Methods

Through a Failure Mode and Effects Analysis (FMEA) in which professionals from the surgical area of ​​the Torrecárdenas University Hospital, Jaén Hospital Complex and Gregorio Marañón General University Hospital participated, aspects that threaten patient safety in spine surgery and that are not included in the WHO generic surgical checklist were proposed. The authors scored each of the proposed items incrementally based on the degree of suitability. Based on the score obtained, they selected those who would be incorporated into the specific safety checklist.

Results

A total of twenty-one candidate items were proposed to be part of the specific check list. These obtained scores between 15 and 11 points. After scoring them, it was decided to include the thirteen best rated in the definitive surgical checklist, seven of them in the initial phase, two in the phase prior to the incision and another four in the final part of the checklist prior to the completion of the procedure.

Conclusions

Professionals in the surgical area of ​​Neurosurgery can identify aspects not included in the generic checklist whose non-compliance can affect patient safety in spine surgery to at least the same extent as those included in WHO checklist.

It is possible to propose a specific complementary checklist for spinal surgery, responsible for collecting aspects related to safety and success in these procedures.

Keywords:
Supplementary surgical checklist
Neurosurgery
Spine surgery
Patient safety
Clinical management
Resumen
Introducción

Una vez estandarizado el listado de verificación quirúrgica genérico de la Organización Mundial de la Salud (OMS) y siguiendo el itinerario propuesto por esta, corresponde a las diferentes especialidades y superespecialidades seguir avanzando en el perfeccionamiento y ajuste de los listados de verificación a los procedimientos que las definen.

Métodos

Mediante un Análisis Modal de Fallos y Efectos (AMFE) en el que participaron profesionales del área quirúrgica del Hospital Universitario Torrecárdenas, Complejo Hospitalario de Jaén y Hospital General Universitario Gregorio Marañón, se propusieron aspectos que amenazan la seguridad del paciente en la cirugía de columna vertebral y que no se encuentran recogidos en el listado de verificación quirúrgica genérico de la OMS. Los autores puntuaron cada uno de los ítems propuestos de forma incremental en función del grado de idoneidad. En base a la puntuación obtenida seleccionaron aquellos que habrían de ser incorporados al listado de verificación quirúrgica específico.

Resultados

Fueron propuestos un total de veintiún ítems candidatos para formar parte del check list específico. Estos obtuvieron calificaciones situadas entre 15 y 11 puntos. Tras la puntación de los mismos se decidió incluir los trece mejor valorados en el listado de verificación quirúrgica definitivo, siete de ellos en la fase inicial, dos en la fase previa a la incisión y otros cuatro en la parte final del check list previa a la finalización del procedimiento.

Conclusiones

Los profesionales del área quirúrgica de Neurocirugía pueden identificar aspectos no incluidos en el check list genérico cuyo no cumplimiento puede condicionar la seguridad del paciente en la cirugía de columna al menos en la misma medida que los incluidos en dicho listado de verificación.

Es posible proponer un listado de verificación complementario específico para la cirugía de columna vertebral, encargado de recoger aspectos relacionados con las seguridad y el éxito en estos procedimientos.

Palabras clave:
Listado de verificación quirúrgica complementario
Neurocirugía
Cirugía de columna
Seguridad del paciente
Gestión clínica

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