Use of an anatomic marking form as an alternative to the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery

A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery

“…After in-depth review, 22 articles met the inclusion criteria and were finally included in the systematic review (Table 1). Of these, 20 were quantitative 3,4,15,16,22,28,30,31,[37][38][39][40][41][42][43][44][45][46][47][48] and 2 were qualitative studies. 14,17 The majority of studies were prospective observational studies, surveys, or analyses of claim reports data.…”

“…Clarke et al 39 Altpeter et al 37 Blanco et al 38 Knight and Aucar 31 Blanco et al 38 16 Data not published. Differences were reported as non-significant…”

“…Whereas 11 studies 3,4,14,16,30,37,40,[42][43][44]48 assessed the overall compliance, only 4 studies 14,37,38,42 assessed the Time Out and 3 studies described failures of compliance of the Time Out 39 or the compliance of different aspects 22 or the compliance and frequency for using a special checklist. 31 Of the studies that collected data in real time or in the assessment, all but 1 22 reported the overall compliance with a range between 12% 14 and 100% 37 (mean: 75%). In the 2 studies which surveyed or interviewed surgical staff members about their overall compliance with the checklist, the fraction of responders that reported being "always or mostly" compliant with the checklist or specific required procedures ranged between 20% and 98%.…”

“…The mean quality score of the 14 quantitative studies that investigated compliance with the checklist was 7.1/18 and the quality score for the 1 qualitative study 14 was better with 12/24. Ten studies 3,4,14,16,22,37,40,42,43,48 collected data about compliance in real time or in the assessment and 5 studies 30,31,38,39,44 by surveying or interviewing surgical staff members. Whereas 11 studies 3,4,14,16,30,37,40,[42][43][44]48 assessed the overall compliance, only 4 studies 14,37,38,42 assessed the Time Out and 3 studies described failures of compliance of the Time Out 39 or the compliance of different aspects 22 or the compliance and frequency for using a special checklist.…”

“…29 The Universal Protocol was developed and implemented in 2003 to 2004, 27 SURPASS in 200727 SURPASS in to 2009 and the WHO checklist in 2007 to 2008. 1,22 The SURPASS checklist covers the whole surgical pathway from admission to discharge, 30 whereas the Universal Protocol includes preprocedure verification, site marking, and a Time Out 31 and the WHO checklist focuses on the period before induction of anesthesia (Sign In), the period after induction and before surgical incision (Time Out), and the period during or immediately after wound closure (Sign Out). 1 As different instruments are available, each institution (or country) has to make a decision on which checklist Investigations into the critical factors of implementation were captured along with the other search strategies.…”