The introduction of a surgical safety checklist in a tertiary referral obstetric centre

Kearns, Rachel; Uppal, Vishal; Bonner, Julia; Robertson, J; Daniel, Michelle; McGrady, Elizabeth

doi:10.1136/bmjqs.2010.050179

Cited by 74 publications

(86 citation statements)

References 9 publications

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“…21,[26][27][28][29] These rates are concordant with the qualitative experience in Calgary, as interviewees reported using some version of the SSC for almost all procedures. However, these rates fail to capture the adherence to the 3 components specifically.…”

Section: Discussionsupporting

confidence: 68%

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

Dharampal

Cameron

Dixon

et al. 2016

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Background: Following a landmark study showing decreased morbidity and mortality after implementation of the surgical safety checklist (SSC), it has been widely adopted into perioperative policy. We explored the impact of attitudes and beliefs surrounding the SSC on its uptake in Calgary. Methods:We used qualitative methodology to examine factors influencing SSC use. We performed semistructured interviews based on Rogers' theory of diffusion of innovation. Purposive and snowball sampling were used to identify surgeons, anesthesiologists and operating room nurses from hospitals in Calgary. Data collection and analysis were based on grounded theory. Two individuals jointly analyzed data and achieved consensus on emerging themes.Results: Generated themes included 1) the SSC has brought organization to previous informal perioperative checks, 2) the SSC is most helpful when it is simple, and 3) the 3 current components of the checklist are redundant. The briefing was considered the most important aspect and the debriefing the least important. Initially the SSC was difficult to implement owing to a shift in time management and perioperative culture; however, it has now assimilated into perioperative routine. Finally, though most participants agreed that the SSC might avoid some delays and complications, only a few believe there have been observable improvements to morbidity and mortality. Conclusion:Although the SSC has been integrated into perioperative practice in Calgary, participants believe that previous informal checkpoints were able to circumvent most perioperative issues. Although the SSC may help with flow and equipment, participants believe it fails to show a subjective, clinically important improvement.Contexte : Après une étude charnière ayant montré une baisse de la morbidité et de la mortalité après la mise en oeuvre de la liste de contrôle de la sécurité chirurgicale, cette dernière a été largement intégrée aux politiques périopératoires. Nous avons examiné l'effet des attitudes et des croyances entourant la liste sur son adoption à Calgary.Méthodes : À l'aide d'une méthode qualitative, nous nous sommes penchés sur les facteurs influençant l'utilisation de la liste. Pour ce faire, nous avons effectué des entrevues semi-dirigées fondées sur la théorie de la diffusion de l'innovation de Rogers. Nous avons utilisé l'échantillonnage dirigé et le sondage en boule de neige pour cibler des chirurgiens, des anesthésiologistes et des membres du personnel infirmier de salle d'opération des hôpitaux de Calgary. La collecte et l'analyse des données étaient fondées sur la théorie ancrée. Deux personnes ont analysé ensemble les données et se sont entendues sur les thèmes émergents.Résultats : Voici les principales conclusions dégagées : 1) la liste a permis de structurer les contrôles périopératoires non officiels du passé, 2) la liste est surtout utile quand elle est simple et 3) les 3 composantes actuelles de la liste de contrôle sont redondantes. Le breffage était considéré comme étant l'aspect le plus important e...

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Section: Discussionsupporting

confidence: 68%

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

Dharampal

Cameron

Dixon

et al. 2016

cjs

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“…5,[18][19][20][21][22][23] Specifically, use of the WHO SSC has shown a decrease in inpatient morbidity and mortality 2,[4][5][6][7]24 as well as improvement in teamwork skills, communication, and adherence to process measures. 1,23,[25][26][27] Nevertheless, Ko et al's recent systematic review of checklist use in medicine has shown limited evidence of their effectiveness. 28 Analysis of the studies indicated that many were of poor quality with low levels of evidence and a high rate of bias.…”

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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“…32,33,35,36 To compare these studies, 4 common aspects encompassing the key issues that WHO-SSC developers claimed the checklist addressed were adopted Within this review, we considered self-perceived benefit of .70% in any of these categories as being significant enough to signify a positive impact. 41 The SSC was reported to have a positive impact on teamwork within the OR in 9 out of 13 studies (Fig.…”

Section: Staff Perceptionmentioning

confidence: 99%

“…The studies spanned across 17 different, countries including both developed and developing nations; the multinational study by Haynes et al 9 incorporated 8 different nations. SSC attitudes were assessed within the context of a single surgical specialty in 3 studies, 34,35,38 while the remaining 10 studies were not specialty specific. The surgical specialties reviewed were obstetrics; ear, nose, and throat; trauma; cardiothoracic; and general.…”

Section: Staff Perceptionmentioning

confidence: 99%

“…Studies used 2 main methodologies to assess team member attitudes: focused interview of a random sample of operating theatre staff (2 studies) 32,33 and a surgical team questionnaire pre-and post-SSC intervention (8 studies). 9,[34][35][36][37][38][39][40] The studies varied in participant size with 37 to 40 participants in focus group studies across the OR disciplines, 32,33 while the surgical team survey questionnaire studies had participant sizes as large as 1748. The surgical questionnaires were based on resources from previous studies or adapted from the surgical attitudes questionnaire (SAQ).…”

Section: Staff Perceptionmentioning

confidence: 99%

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

Wangoo

Ray

2016

International Surgery

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This systematic review aimed to assess surgical safety checklist compliance and evaluate surgical team perceptions and attitudes, post-checklist implementation in the operating room. The World Health Organization (WHO) surgical safety checklist (SSC) has decreased complications and mortality. However, it is unclear whether this reduction is influenced by the vicarious enhancement in teamwork, communication, and staff awareness established by SSC implementation. The preferred reporting items for systematic reviews and meta-analyses model of review guided a search across MEDLINE, PubMed, and Embase databases. English-language studies using any adapted form of the WHO-SSC in operating rooms were reviewed by abstract and full text. Twenty-six studies, 13 assessing SSC compliance and 13 investigating surgical team perceptions of SSC, were evaluated. Compliance studies showed a checklist initiation rate of .90%, but actual observed completion rate varied widely across studies. Sign out was the most poorly performed phase of the checklist (,50%) with time out being the best. Verification of patient identity and procedure demonstrated a high degree (.90%) of compliance across studies, but ''verification of team-members'' was significantly less compliant. Studies assessing surgical team perceptions found that SSC improved participants' perception of teamwork, communication, patient safety, and staff awareness of adverse events. However, when stakeholders placed differing degrees of importance on SSC completion, results indicated the SSC might actually antagonize team relationships. SSC compliance varies significantly across studies, being highly dependent on staff perceptions, training, and effective leadership. Surgical teams have positive perceptions

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The introduction of a surgical safety checklist in a tertiary referral obstetric centre

Cited by 74 publications

References 9 publications

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

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

Surgical safety checklist: implementation in an ambulatory surgical facility

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

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