A 10-item checklist improves reporting of critical procedural elements during transurethral resection of bladder tumor

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

MATERIALS AND METHODS - We formed a multi-institutional group of urologists with expertise in bladder cancer and identified 10 critical items that should be performed during every high-quality TURBT. We prospectively implemented a 10-item checklist into practice and reviewed the operative reports of TURBTs performed before and after implementation. Results from all institutions were combined using a meta-analysis to estimate the overall change in the mean number of items documented.

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

CONCLUSIONS - The use of a 10-item checklist during TURBT improved 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.

The Journal of urology. 2016 Apr 01 [Epub ahead of print]

Christopher Anderson, Ryan Weber, Darshan Patel, William Lowrance, Adam Mellis, Michael Cookson, Maximilian Lang, Daniel Barocas, Sam Chang, Elizabeth Newberger, Jeffrey S Montgomery, Alon Z Weizer, Cheryl T Lee, Bruce R Kava, Max Jackson, Anoop Meraney, Daniel Sjoberg, Bernard Bochner, Guido Dalbagni, Machele Donat, Harry Herr

Department of Surgery, Urology Service. Memorial Sloan Kettering Cancer Center, New York, NY. Department of Epidemiology and Biostatistics. Memorial Sloan Kettering Cancer Center, New York, NY., Department Urology. University of Utah, Salt Lake City, UT., Department Urology. University of Utah, Salt Lake City, UT., Department Urology. University of Oklahoma, Oklahoma City, OK., Department Urology. University of Oklahoma, Oklahoma City, OK., Department Urologic Surgery. Vanderbilt University, Nashville, TN., Department Urologic Surgery. Vanderbilt University, Nashville, TN., Department Urologic Surgery. Vanderbilt University, Nashville, TN., Department Urology. University of Michigan, Ann Arbor, MI., Department Urology. University of Michigan, Ann Arbor, MI., Department Urology. University of Michigan, Ann Arbor, MI., Department Urology. University of Michigan, Ann Arbor, MI., Department Urology. University of Miami Miller School of Medicine, Miami, FL., Department Urology. Hartford Hospital, Hartford, CT., Department Urology. Hartford Hospital, Hartford, CT., Department of Epidemiology and Biostatistics. Memorial Sloan Kettering Cancer Center, New York, NY., Department of Surgery, Urology Service. Memorial Sloan Kettering Cancer Center, New York, NY., Department of Surgery, Urology Service. Memorial Sloan Kettering Cancer Center, New York, NY., Department of Surgery, Urology Service. Memorial Sloan Kettering Cancer Center, New York, NY., Department of Surgery, Urology Service. Memorial Sloan Kettering Cancer Center, New York, NY.

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