Improving Wake-Up Times for Spine Surgery Using New OR Team Checklist Protocol and Communication
George M. Edwards, BS1, Gabriel Brotzman, DO2, Bryan Max, MD3, Kristina Stanson, PA-C4, Kristy Tyndall, CRNA5, Arturo Suarez, MD6, Kirsten Darroch, PA-C7, Craig Fowler, MD8 and Lloyd A. Hey, MD, MS9*
1 Brody School of Medicine at East Carolina University, 600 Moye Blvd., Greenville, NC 27834, USA.
6 Duke University, 2301 Erwin Rd, Durham, NC 27710, USA.
2,8 Jerry Wallace School of Osteopathic Medicine at Campbell University, 4350 U.S. 421 South Lillington, NC 27546 USA.
4,7,9 Hey Clinic for Scoliosis and Spine Care, 3320 Wake Forest Rd #450, Raleigh, NC 27609 USA.
3,5 WakeMed Hospital, 3000 New Bern Ave, Raleigh, NC 27610, USA.
*Corresponding Author: Lloyd A. Hey, MD, MS, Hey Clinic for Scoliosis and Spine Care, 3320 Wake Forest Rd #450, Raleigh, NC 27609, USA.
DOI: https://doi.org/10.58624/SVOAOR.2023.03.058
Received: October 17, 2023 Published: November 02, 2023
Abstract
Introduction: Prolonged post-anesthesia wake-up times present a threat to patient safety. Shorter wake-up times allow for intraoperative physical exams and potential to re-operate quickly in case of detected neurologic deficits, which may allow for a better neurologic outcome. Furthermore, shorter wake-ups may reduce length of hospital stay, lowering healthcare costs.
Methods: We studied how a standardized spine deformity surgery checklist and new OR team communication impacted post-anesthesia wake-up times after scoliosis surgery. We used a Kruskal-Wallis one-way ANOVA to compare 17 wake-up times recorded prior to using the new surgery checklist and teamwork protocol to 468 wake-up times recorded over three years after implementation of the new protocol. We used a Pearson correlation coefficient to analyze how wake-up times varied based on surgical duration with the new protocol.
Results: After one year of the new protocol, wake-up times reduced from an average of 16.6 minutes to an average of 7.6 minutes. Wake-up times further declined to an average of 6.0 minutes by years two and three of the new protocol, with significant reductions in these years (p=0.024 and p=0.030, respectively). Improvements to the protocol were made over time in response to outliers. Nearly 75% of wake-up times were less than five minutes with the new protocol. Wake-up times recorded using the new protocol showed a significant weak positive correlation with surgical duration (r=0.092, p=0.047).
Conclusion: The standardized surgery checklist and new team communication promotes significantly shorter post-anesthesia wake-up times, irrespective of surgical duration. While using a comprehensive surgery checklist may take a few more minutes up front, that time is saved at the end with shorter wake-up time, creating net time savings while improving safety. Key steps to promoting a shorter intraoperative wake-up include: 1) using a bispectral index monitor (BIS) with a goal in the 50s, 2) standardized target anesthetic dosing parameters, 3) eliminated anesthetic drug variability, 4) every-thirty-minute timeouts to monitor patient status, and 5) sub-three-minute pre-surgery wake-up time goals verbalized to the OR team.
Keywords: Surgery Checklist, Teamwork, Anesthesia Wake-Up Times, Scoliosis
Citation: Edwards GM, Brotzman G, Max B, Stanson K, Tyndall K, Suarez A, Darroch K, Fowler C, Hey LA. Improving Wake-Up Times for Spine Surgery Using New OR Team Checklist Protocol and Communication. SVOA Orthopaedics 2023, 3:6, 174-182.