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Multicenter Study
. 2016 Oct;196(4):1014-20.
doi: 10.1016/j.juro.2016.03.151. Epub 2016 Apr 1.

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor

Christopher Anderson  1 , Ryan Weber  2 , Darshan Patel  3 , William Lowrance  3 , Adam Mellis  4 , Michael Cookson  4 , Maximilian Lang  5 , Daniel Barocas  5 , Sam Chang  5 , Elizabeth Newberger  6 , Jeffrey S Montgomery  6 , Alon Z Weizer  6 , Cheryl T Lee  6 , Bruce R Kava  7 , Max Jackson  8 , Anoop Meraney  8 , Daniel Sjoberg  2 , Bernard Bochner  9 , Guido Dalbagni  9 , Machele Donat  9 , Harry Herr  9
Affiliations
Multicenter Study

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor

Christopher Anderson et al. J Urol. 2016 Oct.

Abstract

Purpose: Previous studies have demonstrated significant variation in recurrence rates after transurethral resection of bladder tumor, likely due to differences in surgical quality. We sought to create a framework to define, measure and improve the quality of transurethral resection of bladder tumor using a surgical checklist.

Materials and methods: We formed a multi-institutional group of urologists with expertise with bladder cancer and identified 10 critical items that should be performed during every high quality transurethral bladder tumor resection. We prospectively implemented a 10-item checklist into practice and reviewed the operative reports of such resections performed before and after implementation. Results at all institutions were combined in a meta-analysis to estimate the overall change in the mean number of items documented.

Results: The operative notes for 325 transurethral bladder tumor resections during checklist use were compared to those for 428 performed before checklist implementation. Checklist use increased the mean number of items reported from 4.8 to 8.0 per resection, resulting in a mean increase of 3.3 items (95% CI 1.9-4.7) on meta-analysis. With the checklist the percentage of reports that included all 10 items increased from 0.5% to 27% (p <0.0001). Surgeons who reported more checklist items tended to have a slightly higher proportion of biopsies containing muscle, although not at conventional significance (p = 0.062).

Conclusions: The use of a 10-item checklist during transurethral resection of bladder tumor improved the reporting of critical procedural elements. Although there was no clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement.

Keywords: checklist; quality improvement; surgeons; urinary bladder neoplasms; urologic surgical procedures.

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Figures

Figure 1
Figure 1
Absolute difference in the mean number of documented checklist items by institution after checklist implementation and weighted overall estimate by meta-analysis.
Figure 2
Figure 2
Probability of detrusor muscle by number of items documented. Dashed lines represent 95% confidence interval.
See this image and copyright information in PMC

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