Implementation of the Surgical Safety Checklist in Switzerland and Perceptions of Its Benefits: Cross-Sectional Survey

Abstract

ObjectivesTo examine the implementation of the Surgical Safety Checklist (SSC) among surgeons and anaesthetists working in Swiss hospitals and clinics and their perceptions of the SSC.MethodsCross-sectional survey at the 97th Annual Meeting of the Swiss Society of Surgery, Switzerland, 2010. Opinions of the SSC were assessed with a 6-item questionnaire.Results152 respondents answered the questionnaire (participation rate 35.1%). 64.7% respondents acknowledged having a checklist in their hospital or their clinic. Median implementation year was 2009. More than 8 out of 10 respondents reported their team applied the Sign In and the Time Out very often or quasi systematically, whereas almost half of respondents acknowledged the Sign Out was applied never or rarely. The majority of respondents agreed that the checklist improves safety and team communication, and helps to develop a safety culture. However, they were less supportive about the opinion that the checklist facilitates teamwork and eliminates social hierarchy between caregivers.ConclusionsThis survey indicates that the SSC has been largely implemented in many Swiss hospitals and clinics. Both surgeons and anaesthetists perceived the SSC as a valuable tool in improving intraoperative patient safety and communication among health care professionals, with lesser importance in facilitating teamwork (and eliminating hierarchical categories).

Attitudes and beliefs about the surgical safety checklist: Just another tick box?

“…Levy and colleagues 30 noted that despite 100% documentation of SSC completion, not all components of the SSC were completed as defined. 30 Cullati and colleagues 24 found similar results in university hospitals in Switzerland. The "briefing" and "time out" were completed 90% and 83% of the time, respectively; however the "debriefing" was completed only 47% of the time.…”

“…This opinion echoes the sentiment noted in another study in which participants strongly disagreed with the statement "[the SCC] brings no added value to existing safety procedures." 24 The ability of the SSC to have bene fits beyond improved morbidity and mortality has been established within the literature. Health care providers included in the qualitative study by Thomassen and colleagues 25 evaluating nurses' and physicians' acceptance of the SSC felt that it was able to reveal insufficient equipment standardization and improve physiciannurse cooperation.…”

Compliance and Surgical Team Perceptions of WHO Surgical Safety Checklist; Systematic Review

“…4). 9,[32][33][34][35][36]40,42,43 Improvements noted were increased ''team feeling,'' 36 ''strengthened teamwork and efficiency,'' 33 and identified enhanced team communication evidenced by increased discussion of critical events. 40 Studies undertaken 1-year postimplementation reported 47 to 57% of medical personnel found SSC improved communication.…”

“…6). 9,32,34,36,37,39,43 While studies noted differing, yet positive responses about the ability of the SSC to prevent errors, all studies reported only minor improvement in team awareness. Specifically, team members reported that the SSC provided brief pertinent information about patient's history and risk, as well as the required procedure, increasing overall situational awareness.…”

“…15 Importantly in some studies, SSC implementation did not mitigate the professional hierarchy, but can actually accentuate the power differential due to its perceived ''staged'' nature. 38,40,43,48 OR staff perception studies suggest that OR nursing personnel perceive maximum benefit from SSC introduction, while surgeons perceive the least positive impact, with anesthetists falling in-between. 32,34,37,40 Education prior to implementation needs to consider the results of these studies in relation to lead roles within the OR.…”