Effectiveness of pre-anesthetic induction checklist in improving general anesthesia induction set-up in a simulated setting during the COVID-19 pandemic

ABSTRACT

Background@#Anesthesiologists being under high pressure and in a stressful environment may predispose to poor pre-induction preparation. The pre-induction period was identified to be a circumstance where medical errors occur. Thus, routine use of checklists is implemented to prevent these. @*Methods@#A Pre-Anesthesic Induction Checklist was formulated and validated by the members of Department of Anesthesiology and Perioperative Medicine staff. The study was designed as a pragmatic trial, quality improvement, and quasi-experimental conducted in the hospital's main operating room in a simulated setting. The participants included sixteen (16) anesthesiology residents who were divided into two groups, without a checklist and with a checklist, with an equal number of residents per year level who underwent eight simulated general anesthesia induction set-ups each. @*Results@#The checklist was used in 64 out of 128 simulations. The group with the checklist had an average completeness score of 95.26% and an average duration of 7.06 minutes compared to the group without the checklist, which had an average score of 70.81% and an average time of 8.75 minutes. Thus, there is an average 24.45% decrease in missed steps and an average 1.69-minute decrease in preparation duration among the residents who used the checklist. In the 128 simulations done, the most common actions and items missed of >20% are the following Succinylcholine (67.97%), laryngeal mask airways (62.50%), confirmation of identifying factors of patients (55.47%), checking of vaporizer (42.97%), checking of sodasorb (36.72%), checking of breathing circuit (30.47%), video laryngoscope (26.56%), and suction (25.00%). @*Conclusion@#The mean total duration of preparation and mean completeness score between with checklist and without checklist groups are significantly different, both having a p-value of <0.0001. The Pre-Anesthetic Induction Checklist significantly reduced the number of missed steps and the duration of preparation time of a simulated pre-anesthesia induction period.