Abstract
BackgroundSurgical safety checklists (SSCs) are designed to improve team communication and consistency in care, ultimately avoiding complications. In Colorado, hospitals reported that use of SSCs was standard practice, but a statewide survey indicated that SSC use was inconsistent. The purpose of this project was to directly observe the compliance with the SSC in Colorado hospitals, through direct observation of the perioperative checklist process.MethodsTen hospitals participated in a quality improvement initiative. Trained team members recorded compliance with each of the components of the SSC. Data analysis was performed using a chi-squared test or ANOVA, depending on the number of categorical variables, with p < 0.05 determining statistical significance.ResultsTen hospitals representing statewide diversity submitted 854 observations (median 98, range 24–106). 83% of cases were elective, 13% urgent, and 4% emergent/trauma. There was significant variation across hospitals in: team introductions, cessation of activity, affirming correct procedure, assessing hypothermia risk, need for beta blocker, or VTE prophylaxis. Uniformly poor compliance was observed with respect to assessment of case duration, blood loss, anesthesiologists’ concerns, or display of essential imaging. Only 71% of observers reported active participation by physicians; 9% reported that “the majority did not pay attention” and 4% reported that the team was “just going through the motions”. There were significant differences among surgical specialty groups in the majority of the elements.ConclusionSSCs have been implemented by the vast majority of hospitals in our state; however, compliance with SSC completion in the operating room has wide variation and is generally suboptimal. Although this study was not designed to correlate SSC compliance with outcomes, there are concerns about the risk of a sentinel event or unanticipated complication resulting from poor preparation.
Highlights
Surgical safety checklists (SSCs) are designed to improve team communication and consistency in care, avoiding complications
Compared with orthopedic and neurosurgeons, general surgeons were more compliant with active participation. In this observational study, we have found that over 90% of Colorado hospitals reported utilizing checklists in the operating room (OR), compliance with the Colorado surgical safety checklist (SSC) is consistently inconsistent and incomplete
Pickering and colleagues [3] observed 294 operations performed over five different hospitals in the United Kingdom, and reported results similar to ours: administrative audits indicated use of checklists in 95% of cases, active participation was observed in only 73%, and all information was communicated in just 55% of cases [3]
Summary
Surgical safety checklists (SSCs) are designed to improve team communication and consistency in care, avoiding complications. In Colorado, hospitals reported that use of SSCs was standard practice, but a statewide survey indicated that SSC use was inconsistent. The purpose of this project was to directly observe the compliance with the SSC in Colorado hospitals, through direct observation of the perioperative checklist process. This study, supported by the World Health Organization (WHO), described the use of a 19-item surgical safety checklist (SSC) that was designed to improve team communication and consistency in care in the perioperative period.
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