Implementation Of Surgical Safety Checklists Research Articles

Attitudes towards surgical safety checklists among American College of Veterinary Surgeons diplomates.

To examine attitudes towards surgical safety checklists (SSCs) among American College of Veterinary Surgeons (ACVS) diplomates and to identify barriers to implementation. Qualitative online research survey. A total of 1282 current ACVS diplomates. An anonymous online survey was distributed to current ACVS diplomates via email. ACVS diplomates were identified using publicly available data through the ACVS website. A total of 1282 surveys were electronically distributed, and respondents were given 4 weeks to respond. The survey consisted of 34 questions examining (1) demographic information, (2) current use of SSCs, (3) knowledge and attitudes towards SSCs, (4) perceived advantages and disadvantages to use of SSCs, (5) implementation strategies, and (6) potential reasons for noncompletion of SSCs. Survey response rate was 20% (257/1282). A total of 169 of 249 (67.9%) respondents indicated using SSCs. Respondents generally agreed that SSCs were proven to reduce surgical complications (196/249 [8.7%]) and did not perceive any disadvantages to use (100/138 [75.2%]). Respondents not using SSCs were more likely to perceive them as a waste of time (p < .001). The most common reasons for noncompletion of SSCs were forgetfulness (21/52 [39.6%]) and time constraints (19/52 [36.5%]). Improved training (72/138 [52.2%]) and modifying the SSC based on staff feedback (69/138 [50%]) were suggested as methods to improve SSC uptake. Respondents currently using SSCs were generally satisfied. Time constraints and memory related issues were common causes for noncompletion of SSCs. Efforts to expand the implementation of SSCs in veterinary surgery should focus on improved engagement of relevant stakeholders and modification of the SSC to suit local conditions.

The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway

BackgroundIn spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams’ perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department.MethodsThis qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke’s method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes.ResultsThe analysis process resulted in three themes describing the participants’ perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning.ConclusionsThis study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals’ competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.

Surgery and Anesthesia Preoperative "Virtual Huddle": A Pilot Trial to Enhance Communication across the Drape.

Effective communication between surgeons and anesthesiologists is critical for high-quality, safe, and efficient perioperative patient care. Despite widespread implementation of surgical safety checklists and time-outs, ineffective team communication remains a leading cause of patient safety events in the operating room. To promote effective communication, we conducted a pilot trial of a "virtual huddle" between anesthesiologists and surgeons. Attending anesthesiologists and surgeons at an academic medical center were recruited by email to participate in this feasibility trial. An electronic health record-based smartphone application was utilized to create secure group chats among trial participants the day before a surgery. Text notifications connected a surgeon/anesthesiologist pair in order to introduce colleagues, facilitate a preoperative virtual huddle, and enable open-ended, text message-based communication. A 5-point Likert scale-based survey with a free-text component was used to evaluate the utility of the virtual huddle and usability of the electronic platform. A total of 51 unique virtual huddles occurred between 16 surgeons and 12 anesthesiologists over 99 operations. All postintervention survey questions received a positive rating (range: 3.50/5.00-4.53/5.00) and the virtual huddle was considered to be easy to use (4.47/5.00), improve attending-to-attending communication (4.29/5.00), and improve patient care (4.22/5.00). There were no statistically significant differences in the ratings between surgery and anesthesia. In thematic analysis of qualitative survey results, Participants indicated the intervention was particularly useful in interdisciplinary relationship-building and reducing room turnover. The huddle was less useful for simple, routine cases or when participation was one sided. A preoperative virtual huddle may be a simple and effective intervention to improve communication and teamwork in the operating room. Further study and consideration of broader implementation is warranted.

Implementing an infection control checklist May not be effective in reducing the incidence of surgical site infections in spinal surgery.

Surgical site infections (SSI) in instrumented spine surgery remains as a major complication with increased morbidity. Although implementation of surgical safety checklists has been reported to lower the rates of SSI, reproducibility of these remain unclear. The specific aim of this study was to explore the results of implementation of a SSI control protocol in regard to its efficacy in decreasing the rate of SSI. A total of 140 instrumented spinal surgery cases between 2018 and 2021 were divided into two groups as Group 1 (checklist implemented) and Group 2 (control) and these were compared regarding SSI rates, patient rand surgery related factors, laboratory findings and infecting microorganisms. Ten SSIs were encountered in Group 1 (20.8%), whereas only nine in Group 2 (9.8%). Although not statistically significant (p > .05), these results highly favor the non-checklist implemented group regarding the development of SSI. A definitive infective microorganism could be identified in five out of 10 SSI in Group 1 and 6 out of nine in Group 2. Whereas only three out of 11 (27.3%) involved Gr (+) agents, rest of eight out of 11 (72.7%) involved Gr (-) agents. A failure in decreasing the SSI rate through the implementation of a SSI prevention checklist may be due to several factors pertaining to the study design, patient characteristics and the Gr (-) dominance in SSIs in our center. Nevertheless, this suggests that checklist implementation to prevent SSI in instrumented spine surgery may not be effective in all contexts.

Effect Of Surgical Safety Checklists On Gastric Cancer Outcomes: A Single-Center Retrospective Study.

AimsSurgery is the primary treatment option for patients with gastric cancer, however the rate of postoperative complications are still high. The implementation of surgical safety checklists (SSCs) has been shown to reduce morbidity and mortality. This study aimed to evaluate the effect of SSCs on the clinical outcomes of gastric cancer.MethodsA total of 881 gastric cancer patients who underwent D2 gastrectomy from May 2009 to April 2011 in a large teaching hospital in China were included in this retrospective study. Patients were matched and divided into the control group (SSC nonimplementation) and intervention group (SSC implementation). The outcomes including intraoperative condition, postoperative complications, and prognosis were then compared between the groups.ResultsThe control group comprised 414 patients (47.0%), and the intervention group included 467 patients (53.0%). Patients in the intervention group had a significantly shorter length of postoperative stay (P < 0.001). Operation time, blood loss, blood transfusion, and hospital charges were comparable between the two groups (all P > 0.05). SSC was not associated with postoperative complications (all P > 0.05). Overall survival was also comparable between patients in the two groups (P > 0.05).ConclusionThe implementation of an SSC was associated with a decreased length of postoperative stay in gastric cancer patients following D2 gastrectomy but did not significantly affect the other outcomes.

Implementation of a surgical safety checklist for dental implant surgeries in a prosthodontics residency program

Statement of problemSurgical safety checklists are commonly used in medical surgery to reduce errors, yet they are rarely used in the dental office. Presently, research on the implementation of surgical safety checklists in implant dentistry and user adherence is lacking. PurposeThe primary purpose of this quality assessment study was to evaluate user compliance by using a surgical safety checklist for dental implant surgeries in a postgraduate prosthodontics program at the University of Connecticut School of Dental Medicine. The secondary purpose was to identify and analyze the nature, number, and frequency of omitted items on the surgical safety checklist. Material and methodsAll surgical safety checklists completed by 8 prosthodontic residents from 120 dental implant surgeries over the course of 1 academic year were collected as part of the program's quality assessment. Each surgical safety checklist contained 12 preoperative items and 14 postoperative items, giving a total of 26 items to be analyzed for each dental implant surgery. The collected data were then analyzed for user compliance, as well as the nature, number, and frequency of omitted items. ResultsSurgical safety checklists from 120 dental implant surgeries encompassing 262 implants were accessed for the academic year cycle from July 2017 to June 2018. There were 6 additional dental implant surgeries whose checklists were inaccessible. There was a 100% compliance rate for surgical safety checklist completion by all 8 prosthodontic residents across 120 dental implant surgeries. Within the checklists, the rate of incomplete responses or omissions was 2.4% (n=77). The 5 most commonly omitted items on the checklist by residents were preoperative photographs (0.29%), postoperative analgesics or steroids (0.26%), preoperative oral antiseptic rinse (0.22%), postoperative prescriptions (0.19%), and signed prosthodontic treatment plan forms (0.16%). ConclusionsThere was excellent compliance with the implemented dental implant surgical safety checklist across 8 prosthodontic residents, and the number of omitted items was small. Surgical safety checklists appear to be a straightforward method of helping prosthodontic residents in their dental implant surgical training to provide consistent and high-quality safe treatment for patients.

An exploration of surgical team perceptions toward implementation of surgical safety checklists in a non-native English-speaking country

In-depth information on the success and failure of implementing the World Health Organization surgical safety checklist (SSC) has been questioned in non-native English-speaking countries. This study explored the experiences of SSC implementation and documented barriers and strategies to improve SSC implementation. A qualitative study was performed in 33 Thai hospitals. The information from focus group discussions with 39 nurses and face-to-face, in-depth interviews with 50 surgical personnel was analyzed using content analysis. Major barriers were an unclear policy, inadequate personnel, refusals and resistance from the surgical team, English/electronic SSC, and foreign patients. The key strategies to improve SSC implementation were found to be policy management, training using role-play and station-based deconstruction, adapting SSC implementation suitable for the hospital's context, building self-awareness, and patient involvement. The barriers of SSC were related to infrastructure and patients. Effective policy management, teamwork and individual improvement, and patient involvement may be the keys to successful SSC implementation.

A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital.

The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. The association of the introduction of SSCs with 90-day mortality remains unclear. To assess the association between the implementation of SSCs and all-cause 90- and 30-day mortality rates. Evaluation of the outcomes of surgical procedures performed during the 6 months before (January 1 to June 30, 2010) and after (January 1 to June 30, 2013) the introduction of SSCs by retrospective analysis of administrative databases. The study was conducted in a public, regional, university-affiliated hospital in Italy. Data were collected from October 23, 2013, to November 12, 2014, including 90-day all-cause mortality, 30-day all-cause mortality, length of hospital stay, and 30-day readmission rate among patients undergoing noncardiac surgery. Patients undergoing surgery during the 6-month periods before and after the implementation of SSCs were compared. Data were analyzed from September 17, 2014, to July 31, 2015. Risk-adjusted rates of 90- and 30-day mortality, readmission rate, and length of stay. The total study sample of 10 741 patients included 5444 preintervention and 5297 postintervention patients (5093 [47.4%] male and 5648 [52.6%] female patients; mean [SD] age, 53.0 [23.0] years). Ninety-day all-cause mortality was 2.4% (129 patients) before compared with 2.2% (118 patients) after the SSC implementation, for an adjusted odds ratio (AOR) of 0.73 (95% CI, 0.56-0.96; P = .02). Thirty-day all-cause mortality was 1.36% (74 patients) before compared with 1.32% (70 patients) after the SSC implementation, for an AOR of 0.79 (95% CI, 0.56-1.11; P = .17). Thirty-day readmission occurred in 797 patients (14.6%) in the preimplementation group vs 766 patients (14.5%) in the postimplementation group, for an AOR of 0.90 (95% CI, 0.81-1.01; P = .79). The adjusted length of stay was 10.4 (95% CI, 10.3-10.6) days in the preimplementation group compared with 9.6 (95% CI, 9.4-9.7) days in the postimplementation group (P < .001). The data cannot prove causality owing to the study design. The implementation of SSCs was associated with a 27% reduction of the adjusted risk for all-cause death within 90 days but not within 30 days. The adjusted length of stay was reduced after implementation of SSCs.

Effect of surgical safety checklists on pediatric surgical complications in Ontario.

In health care, most preventable adverse events occur in the operating room. Surgical safety checklists have become a standard of care for safe operating room practice, but there is conflicting evidence for the effectiveness of checklists to improve perioperative outcomes in some populations. Our objective was to determine whether surgical safety checklists are associated with a reduction in the proportion of children who had perioperative complications. We conducted a retrospective cohort study using administrative health care databases housed at the Institute for Clinical Evaluative Sciences to compare the risk of perioperative complications in children undergoing common types of surgery before and after the mandated implementation of surgical safety checklists in 116 acute care hospitals in Ontario. The primary outcome was a composite outcome of 30-day all-cause mortality and perioperative complications. We identified 14 458 and 14 314 surgical procedures in pre- and postchecklist groups, respectively. The proportion of children who had perioperative complications was 4.08% (95% confidence interval [CI] 3.76%-4.40%) before the implementation of the checklist and 4.12% (95% CI 3.80%-4.45%) after implementation. After we adjusted for confounding factors, we found no significant difference in the odds of perioperative complications after the introduction of surgical safety checklists (adjusted odds ratio 1.01, 95% CI 0.90-1.14, p = 0.9). The implementation of surgical safety checklists for pediatric surgery in Ontario was not associated with a reduction in the proportion of children who had perioperative complications. ClinicalTrials.gov, no. NCT02419053.

Implementation of the Surgical Safety Checklist in South Carolina Hospitals Is Associated with Improvement in Perceived Perioperative Safety

Previous research suggests that surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room. As part of the Safe Surgery 2015 initiative to implement SSCs in South Carolina hospitals, we administered a validated survey designed to measure perception of multiple dimensions of perioperative safety among clinical operating room personnel before and after implementation of an SSC. Thirteen hospitals administered baseline and follow-up surveys, separated by 1 to 2 years. Response rates were 48.4% at baseline (929 of 1,921) and 42.7% (815 of 1,909) at follow-up. Results suggest improvement in all of the 5 dimensions of teamwork (relative percent improvement ranged from+2.9% for coordination to+11.9% for communication). These were significant after adjusting for respondent characteristics, hospital fixed-effects, multiple comparisons, and clustering robust standard errors by hospital (all p < 0.05). More than half of respondents (54.1%) said their surgical teams always used checklists effectively; 73.6% said checklists had averted problems or complications. A large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.

Lessons from aviation safety: "plan your operation - and operate your plan!".

Lessons from aviation safety: "plan your operation - and operate your plan!".

Impact of Perceptions of Patient Safety on Planning and Implementation of Surgical Safety Checklists

Study ObjectiveTo assess variation in perceptions of patient safety among surgical staff to better understand how these differences may impact planning and implementation of a surgical safety checklist.DesignPopulation survey.Setting31 South Carolina hospitals implementing surgical safety checklists.PatientsSurgical team members (physicians, nurses, technicians, and administrative staff).InterventionA surgical safety culture survey was distributed to surgical staff during implementation of surgical safety checklists. The survey included a free text section for comments and feedback. Free text comments related to patient safety were reviewed by two investigators and classified into 11 categories. In addition, these comments were classified as positive, negative, or neutral and analyzed according to self-reported professional discipline.Measurements and Main ResultsTabled 1Comments by Type of TrainingCategoryAll (n = 165)All MD (n = 43)RN (n = 86)Tech/admin (n = 21)Other (n = 15)p∗Chi-squares and Fisher's exact test were used to determine p-valueBuy-in27 (16.4)9 (20.9)13 (15.1)0 (0.0)4 (26.7)0.04Turnover times/Time considerations22 (13.3)1 (2.3)16 (18.6)4 (19.0)1 (6.7)0.03Hospital leadership/management/administration21 (12.7)5 (11.6)10 (11.6)5 (23.8)1 (6.7)0.45Team Communication18 (10.9)2 (4.7)8 (9.3)5 (23.8)3 (20.0)0.06Quality/effectiveness of the checklist16 (9.7)11 (25.6)5 (5.8)0 (0.0)0 (0.0)0.001Other16 (9.7)3 (7.0)11 (12.8)1 (4.8)1 (6.7)0.70Influence of an individual11 (6.7)2 (4.7)8 (9.3)0 (0.0)1 (6.7)0.56No issues11 (6.7)4 (9.3)2 (2.3)2 (9.5)3 (20.0)0.03OR logistics/equipment issues10 (6.1)1 (2.3)7 (8.1)2 (9.5)0 (0.0)0.46Staffing Issues7 (4.2)1 (2.3)5 (5.8)0 (0.0)1 (6.7)0.58Freedom to speak up6 (3.6)3 (7.0)1 (1.2)2 (9.5)0 (0.0)0.09∗ Chi-squares and Fisher's exact test were used to determine p-value Open table in a new tab ConclusionIn this study, physicians were more likely to comment on the poor quality/ineffectiveness of surgical checklists. Non-physicians expressed significant concern regarding lack of physician buy-in and time constraints. Results raise concern regarding physician compliance. An institution's insight about perceptions of safety and differences between physicians and other OR staff may facilitate successful implementation of surgical safety checklists. Targeting specific concerns prior to and during implementation of surgical safety checklists may improve adoption and efficacy of these measures. Study ObjectiveTo assess variation in perceptions of patient safety among surgical staff to better understand how these differences may impact planning and implementation of a surgical safety checklist. To assess variation in perceptions of patient safety among surgical staff to better understand how these differences may impact planning and implementation of a surgical safety checklist. DesignPopulation survey. Population survey. Setting31 South Carolina hospitals implementing surgical safety checklists. 31 South Carolina hospitals implementing surgical safety checklists. PatientsSurgical team members (physicians, nurses, technicians, and administrative staff). Surgical team members (physicians, nurses, technicians, and administrative staff). InterventionA surgical safety culture survey was distributed to surgical staff during implementation of surgical safety checklists. The survey included a free text section for comments and feedback. Free text comments related to patient safety were reviewed by two investigators and classified into 11 categories. In addition, these comments were classified as positive, negative, or neutral and analyzed according to self-reported professional discipline. A surgical safety culture survey was distributed to surgical staff during implementation of surgical safety checklists. The survey included a free text section for comments and feedback. Free text comments related to patient safety were reviewed by two investigators and classified into 11 categories. In addition, these comments were classified as positive, negative, or neutral and analyzed according to self-reported professional discipline. Measurements and Main ResultsTabled 1Comments by Type of TrainingCategoryAll (n = 165)All MD (n = 43)RN (n = 86)Tech/admin (n = 21)Other (n = 15)p∗Chi-squares and Fisher's exact test were used to determine p-valueBuy-in27 (16.4)9 (20.9)13 (15.1)0 (0.0)4 (26.7)0.04Turnover times/Time considerations22 (13.3)1 (2.3)16 (18.6)4 (19.0)1 (6.7)0.03Hospital leadership/management/administration21 (12.7)5 (11.6)10 (11.6)5 (23.8)1 (6.7)0.45Team Communication18 (10.9)2 (4.7)8 (9.3)5 (23.8)3 (20.0)0.06Quality/effectiveness of the checklist16 (9.7)11 (25.6)5 (5.8)0 (0.0)0 (0.0)0.001Other16 (9.7)3 (7.0)11 (12.8)1 (4.8)1 (6.7)0.70Influence of an individual11 (6.7)2 (4.7)8 (9.3)0 (0.0)1 (6.7)0.56No issues11 (6.7)4 (9.3)2 (2.3)2 (9.5)3 (20.0)0.03OR logistics/equipment issues10 (6.1)1 (2.3)7 (8.1)2 (9.5)0 (0.0)0.46Staffing Issues7 (4.2)1 (2.3)5 (5.8)0 (0.0)1 (6.7)0.58Freedom to speak up6 (3.6)3 (7.0)1 (1.2)2 (9.5)0 (0.0)0.09∗ Chi-squares and Fisher's exact test were used to determine p-value Open table in a new tab ConclusionIn this study, physicians were more likely to comment on the poor quality/ineffectiveness of surgical checklists. Non-physicians expressed significant concern regarding lack of physician buy-in and time constraints. Results raise concern regarding physician compliance. An institution's insight about perceptions of safety and differences between physicians and other OR staff may facilitate successful implementation of surgical safety checklists. Targeting specific concerns prior to and during implementation of surgical safety checklists may improve adoption and efficacy of these measures. In this study, physicians were more likely to comment on the poor quality/ineffectiveness of surgical checklists. Non-physicians expressed significant concern regarding lack of physician buy-in and time constraints. Results raise concern regarding physician compliance. An institution's insight about perceptions of safety and differences between physicians and other OR staff may facilitate successful implementation of surgical safety checklists. Targeting specific concerns prior to and during implementation of surgical safety checklists may improve adoption and efficacy of these measures.