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The Zurich Checklist for Safety in the Intraoperative Magnetic Resonance Imaging Suite: Technical Note


Stienen, Martin N; Fierstra, Jorn; Pangalu, Athina; Regli, Luca; Bozinov, Oliver (2019). The Zurich Checklist for Safety in the Intraoperative Magnetic Resonance Imaging Suite: Technical Note. Operative neurosurgery, 16(6):756-765.

Abstract

BACKGROUNDRecently, the use of intraoperative magnetic resonance imaging (ioMRI) has evolved in neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potentially hazardous environment. Strict safety guidelines in the operating room (OR) are necessary. Checklists can minimize errors while increasing efficiency and improving workflow.OBJECTIVETo describe the Zurich checklists for safety in the ioMRI environment.METHODSWe summarize the checklist protocol and the experience gained from over 300 surgical procedures performed over a 4-yr period using this new system for transcranial or transsphenoidal surgery in a 2-room high-field 3 Tesla ioMRI suite.RESULTSParticularities of the 2-room setting used at our institution can be summarized as (1) patient transfer from a sterile to a nonsterile environment and (2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the strength of the magnetic field, or sterility concerns. Each step in the checklist corresponds to a specific phase and particular actions taken during the workflow in the ioMRI suite. Most steps are relevant to any 2-room ioMRI-OR suite.CONCLUSIONThe use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.

Abstract

BACKGROUNDRecently, the use of intraoperative magnetic resonance imaging (ioMRI) has evolved in neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potentially hazardous environment. Strict safety guidelines in the operating room (OR) are necessary. Checklists can minimize errors while increasing efficiency and improving workflow.OBJECTIVETo describe the Zurich checklists for safety in the ioMRI environment.METHODSWe summarize the checklist protocol and the experience gained from over 300 surgical procedures performed over a 4-yr period using this new system for transcranial or transsphenoidal surgery in a 2-room high-field 3 Tesla ioMRI suite.RESULTSParticularities of the 2-room setting used at our institution can be summarized as (1) patient transfer from a sterile to a nonsterile environment and (2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the strength of the magnetic field, or sterility concerns. Each step in the checklist corresponds to a specific phase and particular actions taken during the workflow in the ioMRI suite. Most steps are relevant to any 2-room ioMRI-OR suite.CONCLUSIONThe use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neuroradiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:complications; infection; intra-operative magnetic resonance imaging; surgical checklist; transsphenoidal surgery; two-room concept; safety
Language:English
Date:1 June 2019
Deposited On:30 Aug 2018 09:13
Last Modified:16 May 2019 01:01
Publisher:Oxford University Press
ISSN:2332-4252
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/ons/opy205
PubMed ID:30099512

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Content: Accepted Version
Language: English
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Embargo till: 2019-08-07