Implementation of the G-BA Quality Management Guideline Regarding Surgical Checklist at a University Maximum Care Hospital - Claim and Reality

Abstract

Surgical treatment pathways can favor the development of Adverse Events (AE) due to the inherent complexity of their service delivery. The World Health Organization (WHO) Surgical Safety Checklist (SSC) is an instrument that effectively reduces perioperative morbidity and mortality. Against this background, in 2016 the Federal Joint Committee (G-BA) issued a Quality Management Directive (QM-RL) making the use of checklists mandatory for surgical procedures. The aim of this study was to compare the checklist compliance of all ten surgical organizational units of the University Medical Center Mainz in the second half of 2017 and 2018. In addition to the annex of the SSC, the processing of the subitems »Sign-In«, »Team-Time-Out« and »Sign-Out« was evaluated. A comparison of 2017 with 2018 showed an increase in all parameters (»Creation of checklist« (94.2 / 96.5%), »Sign-In« (81.4 / 84.4%), »Team-Time-Out« (56.8 / 62.4%) and »Sign-Out« (50.7 / 57.9%), without, however, statistical significance (p>0.05). In contrast, there were significant differences between certified and non-certified surgical operating units. The parameters showing significant differences were found to be »Sign-In« (87.9 / 71.8%; p=0.034), »Team-Time-Out« (68.4 / 39.4%; p=0.029) and »Sign-Out« (62.1 / 33.6%; p=0.029) for 2017 and »Team-Time-Out« (76.2 / 41.7%); p=0.019) and the »Sign-Out« (71.3 / 37.9%; p=0.019) for 2018. From 2017 to 2018, there was increased implementation of the SCC, particularly in certified facilities. Therefore, the external control of prescribed quality features, for instance, as part of a certification procedure, appears to be a suitable tool for increasing checklist compliance.