A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery

Borchard, Annegret; Schwappach, David; Barbir, Aline; Bezzola, Paula

doi:10.1097/sla.0b013e3182682f27

Cited by 276 publications

(295 citation statements)

References 44 publications

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“…Key areas that facilitated good implementation were the presence of a checklist champion, effective communication and teamwork, and training of [18] reported that most studies were done in HICs. Haynes et al [4] had four sites in LMICs, and six of the safety indicators had compliance rates of 0%, 18.1%, 92.1% and 56.7% at the four hospitals.…”

Section: Researchmentioning

confidence: 99%

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The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

et al. 2017

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Corresponding author: M Naidoo (naidoom@ukzn.ac.za)Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery. Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres. Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery. Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 -0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 -0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 -1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 -0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL. Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation.

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Section: Researchmentioning

confidence: 99%

“…In a systematic review of 21 studies, Borchard et al [18] concluded that the overall compliance rate ranged from 12% to 100%. Key areas that facilitated good implementation were the presence of a checklist champion, effective communication and teamwork, and training of [18] reported that most studies were done in HICs.…”

Section: Researchmentioning

confidence: 99%

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

et al. 2017

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“…Apparently, a more elaborate explanation is needed for a better understanding of the purpose of the EYEpad, both for patients and nurses. Previous work has suggested the success of checklist implementation largely depends on a clear explanation of the 'why' and 'how' [21]. A better understanding of the 'why' in this study could further improve the feasibility.…”

Section: Limitationsmentioning

confidence: 99%

“…Information technology may substantially contribute to engaging patients in activities to improve patient safety [20,21].…”

Section: Introductionmentioning

confidence: 99%

A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study (Preprint)

Stolk-Vos¹,

Steen²,

Drossaert³

et al. 2018

Preprint

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“…This clinician-led 'in the field' action research allows work flow and clinician acceptability to be built into the iterative process while minimising time or money foregone in the event of failure. Such an approach underpinned highly successful programs for preventing catheter-related bloodstream infections in ICUs 86 and reducing operating theatre mishaps, 87 with resultant cost savings.…”

Section: Convert Health Care Institutions Into Rapidly Learning Organmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery

Abstract: Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed.

Cited by 276 publications

References 44 publications

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study (Preprint)

Ten clinician-driven strategies for maximising value of Australian health care

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