Operating Room Errors: Equipment-Related Failures Common

Joe Barber Jr, PhD

July 25, 2013

Equipment-related errors make up approximately one fifth of all errors that occur in the operating room, according to the findings of a systematic review.

Ruwan A. Weerakkody, PhD, from Imperial College London in the United Kingdom, and colleagues published their findings online July 25 in BMJ Quality and Safety.

In the study, the researchers searched various electronic databases to identify quantitative studies that assessed operating room errors and adverse events. They excluded studies that did not quantify the contribution of equipment or technological failure and those that examined failures outside the scope of surgical procedures. Among the 28 included studies, the median number of errors per procedure was 15.5 (interquartile range [IQR], 2.0 - 17.8), and equipment/technology errors account for a median of 19.3% (IQR, 14.3% - 29.8%) of all errors.

Prospective studies tended to report more errors than self-report assessments (median, 12.2 [IQR, 1.3 - 32.8] vs 0.4 [IQR, 0.17 - 0.9]). A strong correlation between equipment-related error and the total error rate per operation was noted (R 2, 0.76).

In an analysis of 8 studies, a lack of equipment availability accounted for 37.7% (IQR, 19.4% - 47.6%) of all failures, whereas configuration problems accounted for 43.4% (IQR, 22.7% - 73.1%) and direct malfunctioning accounted for 33.5% (IQR, 15.1% - 60.0%).

Among 4 studies that categorized error severity, 21.2% of all errors were considered major, with equipment problems, communication failures, and technical failures accounting for 20.8%, 8%, and 13% of major failures, respectively.

In 6 studies that assessed errors according to operation type, cardiac surgery, compared with general surgery, was associated with higher rates of both equipment errors (2.99 [range, 1.7 - 4.1] vs 0.79 [range, 0.7 - 0.86]) and total errors (18.45 [range, 9.5 - 32.8] vs 2.0 [range, 0 - 5.9]).

In 6 studies that evaluated the effects of interventions on error rates, implantation of the intervention reduced the error rate by 38.5% (range, 20% - 64.2%), including a reduction in the equipment failure rate by an average of 48.6% (range, 7.4% - 83.7%). Among studies that assessed a checklist specifically including an equipment check, the intervention reduced the equipment error rate by a mean of 60.7% (range, 32.4% - 84.7%).

The limitations of the study included an inability to perform meta-analysis, the small numbers of studies that used the same methodological framework to assess error rates in surgeries, and potential bias associated with self-reported studies.

"Equipment-related failures form a substantial proportion of the cause of all error recorded in studies of operating room safety failures, but with widely variable values reported," the authors write. "Further studies are required to quantify the categories of equipment-related error specific to key groups of procedures as well as the effect of checklists."

The study was funded in part by the Imperial College Healthcare Trust and the National Institute for Health Research through the Comprehensive Biomedical Research Centre. The authors have disclosed no relevant financial relationships.

BMJ Qual Saf. Published online July 25, 2013.


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