Is Communication Improved With the Implementation of an Obstetrical Version of the World Health Organization Safe Surgery Checklist?

Abstract

Objective Communication failures are consistently seen as a root cause of preventable adverse outcomes in obstetrics. We assessed whether use of an Obstetric Safe Surgery Checklist for cesarean deliveries (CDs), based on the WHO Safe Surgery Checklist, can improve communication; reduce team member confusion about urgency of the case; and decrease documentation discrepancies among nursing, obstetric, anesthesia, and pediatric staff. Methods Retrospective review of 600 CDs on our 2 labor and delivery suites before and after the introduction of 2 consecutive versions of our obstetric safe surgery checklist (100 cases in each cohort) was undertaken. The first version was released in 2010, and after modifications based on initial findings, our current version was released in 2014. One hundred consecutive CDs were identified from each of the 3 periods at each hospital, and charts for those patients and newborns were abstracted. Notes by obstetricians, nurses, anesthesiologists, and pediatricians were reviewed. We compared the rates of agreement in the documentation of the indication for the CD between the different members of the team. Chi-square analyses were performed. Results Complete agreement among the 4 specialties in the documented indication for CD before introduction of our initial safe surgery checklist was noted in 59% (n = 118) of cases. After initial checklist introduction, agreement decreased to 43% (n = 86; P = 0.002). We then modified our checklist to include indication for CD and level of urgency and changed our policy to include pediatric staff participation in the timeout. Agreement in a subsequent chart review increased to 80% (n = 160), significantly better than in our initial analysis (P < 0.001) and our interim review (P < 0.001). The greatest improvement in agreement was observed between obstetricians and pediatricians. Conclusions Implementation of a safe surgery checklist can improve communication at CDs, but care should be taken when implementing checklists because they can have unanticipated consequences. Ongoing review and modification are critical to ensure safer medical care.

International Perspectives on Modifications to the Surgical Safety Checklist

“…Plus, when considering modifications, teams may identify complex procedures (ie, robotic surgery) or complex patients (ie, neonates) where additional processes need to be considered and important information needs to be communicated. For example, by creating a time-out focused on indications for the cesarean deliveries, the SSC customized by Govindappagari et al 19 increased communication and agreement between health care professionals on the procedure from 59% to 80%.…”

An evidence-based intraoperative communication tool for emergency general surgery: a pilot study

“…12 Through further study, the WHO SSC has been tailored to fit the specific needs of several medical specialties, inclusive of obstetrics and vascular surgery, to good effect. 13,14 In conjunction with checklist tools, team huddle strategies, which are purposeful exchanges of information intended to be used at any point in the continuum of patient care, have been shown to enhance communication between providers of varied disciplines. 15 Neither of these tools, which have advanced modern patient safety practices, has been explicitly examined in EGS.…”