Reality check of using the surgical safety checklist: A qualitative study to observe application errors during snapshot audits

Abstract

BackgroundThe WHO Surgical Safety Checklist (SSC) was established to address important safety issues and to reduce the number of surgical deaths. So far, numerous reports have demonstrated sub-optimal implementation of the SSC in practice and limited improvements in patient outcomes. Therefore, the aim of this study was to audit the SSC-practice in a real-world setting in a university hospital setting.MethodsFrom 2015 to 2016, independent observers performed snapshot audits in operating theatres and shadowed the three phases of the SSC. Using a 4-point Likert-scale to rate the compliance on each audit day, we generated a report highlighting possible improvements and provided feedback to the operating team members.ResultsAudits were performed on 36 operating days (2015: n = 19; 2016: n = 17), in which a total of 136 surgical interventions were observed. Overall, the percentage of “very good compliance” improved from 2015 to 2016: for the sign-in from 52.9% to 81.2% (p = 0.141), for the team-time-out from 33.3% to 58.8% (p = 0.181), and for the sign-out from 21.4% to 41.7% (p = 0.401). The qualitative review revealed inconsistencies when applying the SSC, of which the missing documentation of an actually performed item or the wrong timing for an item was most common.ConclusionSnapshot audits revealed that SSC compliance has improved over the observed period, while its application revealed inconsistencies during the three phases of the SSC. Snapshot audits proved to be a valuable tool in the qualitative analysis of SSC compliance and gave more insight than a mere completeness check of ticks in SSC documents.

Anspruch und Wirklichkeit: Umsetzung der G-BA Qualitätsmanagement-Richtlinie bezüglich der Anwendungspraxis der OP-Checkliste – Status Quo an einem universitären Maximalversorger

“…Lediglich die Gruppe der nicht zertifizierten Zentren bleibt im Kontrolljahr mit 77,9 % hinter dem Vergleichswert der Literatur zurück. Sendlhofer et al (2018) sieht den Grund für die hohen Akzeptanzwerte des »Sign-In« darin, dass hier nur eine Berufsgruppe, die Anästhesie, das Verfahren leitet und im Gegensatz zu den weiteren Parametern (»Team-Time-Out«, »Sign-Out«) keine Interaktion mit weiteren Systempartnern erforderlich ist [29]. Es überrascht in dieser Studie, dass das monodisziplinär zu verantwortende »Sign-In«, im Indexjahr zwischen den zertifizierten und den nicht zertifizierten Zentren ein signifikant unterschiedliches Resultat liefert.…”

“…Die unangekündigte prospektive quantitative Evaluation der OP-Checklisten ist ein probates Mittel für eine Einordnung des Nutzungsverhaltens [29]. Die von uns beobachtete Diskrepanz zwischen Compliance-Raten von »zertifizierten Zentren« (Erst-oder Re-Audit) vs. »nicht zertifizierte Zentren« ist besonders beachtenswert.…”

Using checklists to improve patient safety during anaesthesia

“…When implemented ineffectively, the use of checklists have failed to demonstrate clinical improvements (Sendlhofer and others 2018). Successes and failures in implementation reflect the complex challenges in patient safety and quality improvement (Catchpole and Russ 2015).…”

The timeout procedure in pediatric surgery - effective tool or lip service? A randomized prospective observational study

“…This was confirmed in a study using snapshot audits that found team timeout errors in 40 to 60 percent of cases. [11] Consequently, there remains considerable uncertainty regarding the quality and performance of the surgical checklist timeout procedure, including its true efficacy for picking up critical . CC-BY-NC-ND 4.0 International license It is made available under a perpetuity.…”

“…This was confirmed in a study using snapshot audits that found team timeout errors in 40 to 60 percent of cases. [11] Consequently, there remains considerable uncertainty regarding the quality and performance of the surgical checklist timeout procedure, including its true efficacy for picking up critical 4 mistakes. [12] For checklists to be effective, however, it is not only important that the listed items be mentioned, but also that potential errors be picked up by the team.…”