The effect of a simple checklist on frequent pre‐induction deficiencies

Thomassen, Øyvind; Brattebø, Guttorm; Søfteland, Eirik; Lossius, Hans Morten; Heltne, J-K

doi:10.1111/j.1399-6576.2010.02302.x

Cited by 52 publications

(40 citation statements)

References 20 publications

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“…33,34 In this study, several factors may have contributed to the low compliance within certain areas of the SSC and the failure to use the checklist to improve the primary and secondary outcomes. For a checklist to be effective, users at the ''sharp end'' must appreciate its value.…”

Section: Discussionmentioning

confidence: 99%

Surgical safety checklist: implementation in an ambulatory surgical facility

Morgan

Cunningham

Mitra

et al. 2013

Can J Anesth/J Can Anesth

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Purpose In 2007, the World Health Organization created a Surgical Safety Checklist (SSC) that encompassed a simple set of surgical safety standards. The threefold purpose of this study was to add ambulatory-specific items to the SSC, to introduce the items into an ambulatory surgical facility, and to determine if patient outcomes regarding postoperative pain and nausea/vomiting improved following implementation. In addition, safety attitudes, antibiotic timing, regional anesthesia/nerve blocks, preemptive pain medications, prophylactic antiemetics, length of stay, and hospital admission were also assessed.Methods After Research Ethics Board approval, staff complete a Safety Attitudes Questionnaire. Seven items were added to the SSC. Data were then collected on 180 surgical cases before SSC implementation and 195 cases following implementation. Compliance with each section of the SSC was assessed. Results On postoperative day one, the median (97.5% confidence interval [CI]) difference between pre-and postimplementation pain scores was 0.5 (97.5% CI, 0 to 1; P = 0.13), and the median difference in the rate of postdischarge nausea/vomiting was -8.4% (97.5% CI, -17.9 to 1.1; P = 0.06). There was no improvement in safety attitudes or any of the secondary outcomes, with the exception of the use of preemptive pain medications. Compliance with the three sections of the checklist, i.e., BRIEFING, TIME OUT, and DEBRIEFING was 99.49%, 97.95%, and 96.92%, respectively. There was low compliance in verbalization of the added ''ambulatory-specific items''. Conclusion Potential reasons for lack of uptake and integration include poor ''user'' buy-in, an overly lengthy checklist, and lack of prioritization of ambulatory-specific items. A shortened SSC was developed based on the results of this study. This trial was registered at ClinicalTrials.gov ID: NCT00934310.Author contributions Pamela J. Morgan was involved in the acquisition of funding for this study. Pamela J. Morgan Lisa Cunningham, Wei Wu, Victoria Noguera, and John Semple were involved in the conception and design of the study. Lisa Cunningham, Sohini Mitra, Natalie Wong, and Mary Li were involved in the acquisition of data for the study. Pamela J. Morgan was involved in the interpretation of the data. Pamela J. Morgan, Wei Wu, and Mary Li analyzed the data. Pamela J. Morgan, Lisa Cunningham, and Mary Li were involved in drafting the article. Sohini Mitra, Natalie Wong, Wei Wu, Victoria Noguera, and John Semple were involved in the critical revision of the article. Résumé Objectif En 2007, l'Organisation mondiale de la Sante´a cre´e´une Liste de contrôle de la se´curite´chirurgicale (LCSC) couvrant un ensemble simple de normes de se´curite´pour la chirurgie. L'objectif triple de cette e´tude e´tait d'ajouter des e´le´ments spe´cifiques au contexte ambulatoire a`la LCSC, d'introduire ces e´le´ments dans un centre de chirurgie ambulatoire, et de de´terminer si les devenirs des patients en matie`re de douleur et de nause´es et vomissements postope´ratoires e´taien...

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Section: Discussionmentioning

confidence: 99%

Surgical safety checklist: implementation in an ambulatory surgical facility

Morgan

Cunningham

Mitra

et al. 2013

Can J Anesth/J Can Anesth

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“…Previous studies have reported benefits of checklist use during anesthesia for identifying missing items before induction, 32 improving the quality of postanesthesia handovers, and managing simulated cases of cesarean delivery, 33 local anesthetic systemic toxicity, and OR crisis scenarios. 34,35 One of the major challenges, which will ultimately determine whether a checklist will lead to an improvement in patient safety, is the checklist's acceptance by clinicians.…”

Section: Discussionmentioning

confidence: 99%

An Anesthesia Preinduction Checklist to Improve Information Exchange, Knowledge of Critical Information, Perception of Safety, and Possibly Perception of Teamwork in Anesthesia Teams

Tscholl

Weiss

Kolbe

et al. 2016

Survey of Anesthesiology

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BACKGROUND: An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked). METHODS: A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork. RESULTS: One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60). CONCLUSIONS: This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork. The WHO Guidelines for Safe Surgery also encourage a formal inspection of the anesthetic equipment, breathing circuit, medications, and a patient's anesthetic risk before each case.The reason for introducing the separate anesthesia preinduction checklist (APIC), in addition to the already introduced WHO surgical safety checklist, was that the WHO surgical safety checklist contains only a few supercritical anesthesia items (e.g., checks of saturation sensor, but not electrocardiogram or blood pressure monitoring).In this study, we sought to evaluate whether the APIC complementing the WHO surgical safety checklist is suited to improve 5 team-level outcomes, each shown to be critical surrogate end points for patient safety: information exchange, knowledge of critical information, team members' perceptions of both safety and teamwork, and clinical performance. Figure 1 outlines the series of subitems assessed for the outcome scores: information exchange, knowledge of critical information, and clinical performance...

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“…Very little research has explored how changes in team behaviour can be transferred into the anaesthesia department culture. Perhaps parallels can be drawn with aviation, where pre-operative ⁄ pre-flight checklists are essential, akin to the recently introduced surgical safety campaign [63][64][65][66][67]. It appears that the quality of pre-operative airway assessment is poor and that there is little planning of airway management.…”

Section: Training and Research In Trainingmentioning

confidence: 99%