Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation

Abstract

Background The World Health Organization’s Global Patient Safety Action Plan 2021–2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients’ involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients’ completion. Studies on such checklists are small scale, but they are linked to reduction in length of hospital stay and readmissions. We have previously developed and validated a two-part surgical patient safety checklist (PASC). This study aims to investigate the feasibility of the PASC usage and implementation prior to its use in a large-scale clinical trial. Methods This is a prospective cross-sectional feasibility study, set up as part of the design of a larger stepped-wedge cluster randomised controlled trial (SW-CRCT). Descriptive statistics were used to investigate patient demographics, reasons for not completing the PASC and percentage of PASC item usage. Qualitative patient interviews were used to identify barriers and drivers for implementation. Interview was analysed through content analysis. Results Out of 428 recruited patients, 50.2% (215/428) used both parts of PASC. A total of 24.1% (103/428) of the patients did not use it at all due to surgical or COVID-19-related cancellations. A total of 19.9% (85/428) did not consent to participate, 5.1% (22/428) lost the checklist and 0.7% (3/428) of the patients died during the study. A total of 86.5% (186/215) patients used ≥ 80% of the checklist items. Barriers and drivers for PASC implementation were grouped into the following categories: Time frame for completing the checklist, patient safety checklist design, impetus to communicate with healthcare professionals and support throughout the surgical pathway. Conclusions Elective surgical patients were willing and able to use PASC. The study further revealed a set of barriers and drivers to the implementation. A large-scale definitive clinical-implementation hybrid trial is being launched to ascertain the clinical effectiveness and scalability of PASC in improving surgical patient safety. Trial registration Clinicaltrials.gov: NCT03105713. Registered 10.04.2017

Is self-screening for 'at risk of malnutrition' feasible in a home setting?

“…During the weeks prior to surgery, patients may experience weight loss and changes in their food intake that will impact upon the validity of the correlation statistics. Previously published analysis showed no difference between genders on responding, but demonstrated that the central community hospital had a higher number of non-responders, possibly indicating that patients with more complex surgery and medical conditions were the ones who participated in the study [ 14 ]. In addition, the modifications to NRS 2002 to customize the screening tool for patients’ self-screening may have affected its reliability.…”

“…This prospective trial is part of the "Feasibility study of the Patient Safety Checklist (PASC)” to be used by surgical patients before and after surgery, prior to a stepped wedge cluster randomized controlled trial (SW-CRCT) [ 14 ].…”

“…The power calculation was based on the PASC trail protocol. It was calculated that the present study would require a total of 300 elective surgical patients, across six clusters, over 14 months [ 14 ].…”

“…Self-registration of the nutritional information as part of the PASC [ 14 ], is hereby called the “self-reported screening tool” and was performed at home, up to 3 months prior to surgery. To raise awareness of nutritional status prior to surgery, the patients were asked on the same paper form if they thought they were “at risk of malnutrition” (“yes”/”no”).…”