Organization Surgical Safety Checklist Research Articles

International Perspectives on Modifications to the Surgical Safety Checklist

Modification of the World Health Organization's Surgical Safety Checklist (SSC) is a critical component of its implementation. To facilitate the SSC's use, it is important to know how surgical teams modify their SSCs, their reasons for making modifications, and the opportunities and challenges teams face in SSC tailoring. To study SSC modifications in high-income hospital settings in 5 countries: Australia, Canada, New Zealand, the United States, and the United Kingdom. This qualitative study used semistructured interviews based on the survey used in the quantitative study. Each interviewee was asked a core set of questions and various follow-up questions based on their survey responses. Interviews were conducted from July 2019 to February 2020 in person and online using teleconferencing software. Surgeons, anesthesiologists, nurses, and hospital administrators from the 5 countries were recruited through a survey and snowball sampling. Interviewees' attitudes and perceptions on SSC modifications and their perceived impact on operating rooms. A total of 51 surgical team members and hospital administrators from the 5 countries were interviewed (37 [75%] with >10 years of service; 28 [55%] women). There were 15 (29%) surgeons, 13 (26%) nurses, 15 (29%) anesthesiologists, and 8 (16%) health administrators. Five themes emerged concerning the awareness and involvement in SSC modifications; reasons for modifications; types of modifications; the outcomes of modifications; and perceived barriers to SSC modifications. Based on the interviews, some SSCs may go many years without being revisited or modified. SSCs are modified to ensure they address local issues and standards of practice and that they are fit for purpose. Modifications are also made following adverse events to reduce the risk of reoccurrence. Interviewees described adding, moving, and removing elements from their SSCs, which increased their sense of ownership in their SSC and participation in its performance. Some barriers to modification included leadership and the SSC's inclusion in hospitals' electronic medical record. In this qualitative study of surgical team members and administrators, interviewees described addressing contemporary surgical issues through various SSC modifications. The process of SSC modification may improve team cohesion and buy-in in addition to providing opportunities for teams to improve patient safety.

Compliance With and Barriers to Implementing the Surgical Safety Checklist: A Mixed-Methods Study.

This mixed-methods study aimed to determine nurses' views on the use of the Turkish version of the World Health Organization's Surgical Safety Checklist (SSC). Phase 1 of the study consisted of a survey of perioperative and surgical nursing unit nurses' perceptions on the use of the SSC. The results showed that personnel believed that every step of the checklist was not always applied and that an increased workload and the lack of team cooperation negatively affected the use of the checklist. Phase 2 of the study involved RN circulator interviews and focused on their experiences using the SSC, the obstacles to SSC implementation, and ways to increase compliance. We interviewed 126 nurses during phase 1 and 20 nurses during phase 2. We analyzed the interviews and identified three themes: the importance of using the SSC, barriers to using the checklist, and compliance with the checklist and applicability.

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

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.

Fostering patient safety through health policy innovation: A case study of implementation of the WHO Surgical Checklist in the UK.

The need to seek innovative solutions to the delivery of safe, cost effective healthcare has never been so pressing. Against a backdrop of austere financial circumstances, the focus must be on reducing unnecessary expenditure on patients that come to harm during the course of their treatment. This article uses the World Health Organization (WHO) Surgical Safety Checklist and its implementation as an example of effecting cultural change within an established western healthcare system. By embedding a safety culture within the perioperative management of surgical patients the incidence of adverse outcomes and harm can be reduced, rationalising the cost of delivering healthcare and improving the efficiency of healthcare systems. An understanding of health policy as a vehicle to induce cultural change throughout a healthcare organisation is essential if new safety innovations are to be effectively implemented.

How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties

BackgroundThe World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staffʼs perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored – yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies.MethodsAn ethnographic case study including observations (40 h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis.ResultsWe identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSCʼs practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded.ConclusionWhen the SSC is not integrated within existing risk management strategies, but perceived as an “add on”, its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.

Review of “Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway” by Haugen AS in Ann Surg 269:283–290, 2017

Review of “Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway” by Haugen AS in Ann Surg 269:283–290, 2017

A survey of the ten-year implementation of WHO surgical safety checklist in China

Objective To investigate the current status of the ten-year implementation of the World Health Organization (WHO) surgical safety checklist (SSC) in China. Methods A questionnaire was designed based on the three phases described by the checklist — the period before induction of anaesthesia, the period before skin incision, and the period before patient leaves operating room, taking into account some hotspots and disputes.The questionnaire was sent to the members of the Chinese-based online New Youth Anesthesia Forum through the WeChat platform.Answers were completed by mobile phones or desktop computers.Each WeChat ID number allowed only one answer for each individual participant. Results A total of 3 943 members red the questionnaire invitation, of which 2 121 members completed the questionnaire with an overall completion rate of 53.79%.For checks completed before induction of anesthesia, the percentage of members who routinely practiced checks before induction of anesthesia was 93.35%, the percentage of members who completed each and every element of the checklist was 60.16%, and the percentage of members who selected the element of the checklist the surgeon was not involved in the check was 14.05%.For checks practiced before skin incision, the percentage of members who routinely completed checks before skin incision was 78.22%, the percentage of members who completed each and every element of the checklist was 51.91%, and the percentage of members who selected the element of the checklist surgeons and anesthesiologists routinely stated their own professional key information was 18.24% and 18.81%, respectively.For checks practiced before the patient leaved the operating room, the percentage of members who routinely completed checks before removing the patient from the operating room was 64.26%, and the percentage of members who completed each and every element of the checklist was 44.18%.The percentage of members who was really serious about practicing the checklist was 56.20%.The percentage of members who believed that surgeons should participated in checks practiced before induction of anesthesia was 81.47%.If the member himself or a member of his family needed a surgery, the percentage of members who hoped to implement the checklist was 98.35%.The percentage of members who believed that practicing WHO SSC could reduce the complications of surgery and improve the anesthetic safety of patients was 94.34%. Conclusion The implementing rate of checks practiced before induction of anesthesia is high, while the implementing rates of checks completed before skin incision and before patient leaves operating room are sequentially reduced in China.Although there are some problems with the implementation of WHO SSC, most respondents believe that implementing SSC can improve the anesthetic safety of patients undergoing surgery. Key words: Anesthesia; Surgical safety checklist

WHO Surgical Safety Checklist

It has been 10 years since the implementation of the World Health Organization (WHO) Surgical Safety Checklist [1]. Adverse events in the operating theatre are a global issue and half of them are often avoidable..

A Surgical Team Simulation to Improve Teamwork and Communication across Two Continents: ViSIOT Proof-of-Concept Study

Team communication in operating rooms is problematic worldwide, and can negatively impact patient safety. Although initiatives such as the World Health Organization's Surgical Safety Checklist have been introduced to improve communication, patient safety continues to be compromised globally, warranting the development of new interventions. Video-based social science methods have contributed to the study of communication in UK ORs through actual observations of surgical teams in practice. Drawing on this, the authors have developed a surgical team simulation-training model [Video-Supported Simulation of Interactions in the Operating Theatre (ViSIOT)]. A proof-of-concept study was conducted in the UK and USA to assess if the ViSIOT simulation-training has applicability and acceptability beyond the UK. ViSIOT training was conducted at two simulation centers in the UK and USA over a 10-month period. All surgical team participants completed a questionnaire (that assessed design, education, satisfaction, and self-confidence in relation to the training). Descriptive and inferential statistics were performed for the quantitative data and thematic analysis was conducted for the qualitative data. There was strong agreement from all participants in terms of their perception of the course across all sub-sections measured. Nine themes from the qualitative data were identified. The two countries shared most themes, however, some emerged that were unique to each country. Practical developments in the course design, technology, and recruitment were identified. Evidence of the course applicability in the USA provides further affirmation of the universal need for team communication training within ORs. Further studies are required to assess its effectiveness in improving communication in OR practice.

Adherence to the WHO surgical safety checklist: an observational study in a Swiss academic center

BackgroundThe World Health Organization (WHO) Surgical Safety Checklist is used globally to ensure patient safety during surgery. Two years after its implementation in the University Hospital Basel’s operating rooms, adherence to the protocol was evaluated.MethodsThis mixed method observational study took place in the surgical department of the University Hospital of Basel, Switzerland from April to August 2017. Data collection was via individual structured interviews with selected OR team members regarding checklist adherence and on-site non-participant observations of Team Time Out and Team Sign Out sequences in the OR. Data were subjected to thematic analysis and descriptive statistics compiled.ResultsComprehensive local expert interviews indicated that individual, procedural and contextual variables influenced the application of the checklist. Facilitating factors included well-informed specialists who advocated the use of the Checklist, as well as teams focused on the checklist’s intended process and on its content. In contrast, factors such as staff insecurity, a generally negative attitude towards the checklist, a lack of teamwork, and hesitance to complete the checklist, hindered its implementation.The checklist’s application was evaluated in 104 on-site observations comprising of 72 Team Time Out (TTO) and 32 Team Sign Out (TSO) sections. Adherence to the protocol ranged between 96 and 100% in TTO and 22% in TSO respectively. Lack of implementation of the TSO was mainly due to the absence of one of the key OR team members, who were busy with other tasks or no longer present in the operating room.ConclusionThe study illustrates factors, which foster and hinder consistent application of the WHO surgical safety checklist namely individual, procedural and contextual. It also demonstrates that the TTO was consistently and correctly applied, while the unavailability of key OR team members at sign-out time was the most common reason for omission or incomplete use of the TSO.

Using Performance Management to Implement a Preprocedural Checklist for Gastrointestinal Endoscopy Procedures.

Providing safe patient care is an important focus of healthcare organizations. In surgical settings, mortality rates have been shown to decrease from 1.5% to 0.8% and complication rates from 11% to 7% when institutions use the World Health Organization's Surgical Safety Checklist. In our hospital-based gastrointestinal endoscopy unit, we recognized that inconsistencies in the preprocedural readiness of patients were causing inefficiencies in scheduling. Therefore, we initiated a quality improvement project to determine whether a preprocedural checklist and positive reinforcement for the nurses in the units could improve endoscopy preparation of patients. The checklist was used to prepare patients and to facilitate nurse-to-nurse communications. We completed a 6-week pilot study (preintervention and postintervention). The results demonstrated the importance of having nurses use a checklist in hospital care units to adequately prepare patients and to accurately communicate patient readiness before gastrointestinal endoscopy procedures. Nursing leadership used positive reinforcement as a strategy to encourage the use of the preprocedural checklist. A postpilot survey of nurses involved in the study show that the preprocedural checklist enhanced care and communication between the patient care units and resulted in direct and indirect benefits for nurses and patients.

Scaling Safety: The South Carolina Surgical Safety Checklist Experience.

Proven patient safety solutions such as the World Health Organization's Surgical Safety Checklist are challenging to implement at scale. A voluntary initiative was launched in South Carolina hospitals in 2010 to encourage use of the checklist in all operating rooms. Hospitals that reported completing implementation of the checklist in their operating rooms by 2017 had significantly higher levels of CEO and physician participation and engaged more in higher-touch activities such as in-person meetings and teamwork skills trainings than comparison hospitals did. Based on our experience and the participation data collected, we suggest three considerations for hospital, hospital association, state, and national policy makers: Successful programs must be designed to engage all stakeholders (CEOs, physicians, nurses, surgical technologists, and others); offering a variety of program activities-both lower-touch and higher-touch-over the duration of the program allows more hospital and individual participation; and change takes time and resources.

World Health Organization Surgical Safety Checklist Modification: Do Changes Emphasize Communication and Teamwork?

BackgroundThe World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. MethodsNonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. ResultsOf 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's “Anticipated Critical Events” section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. ConclusionsChecklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's “Anticipated Critical Events” section.

ADAPTAÇÃO E VALIDAÇÃO DE CHECKLIST DE SEGURANÇA CIRÚRGICA NA CESÁREA

RESUMO Objetivo: adaptar e validar um instrumento de segurança cirúrgica na cesárea, com base em revisão integrativa da literatura, e no protocolo e checklist de segurança cirúrgica da Organização Mundial da Saúde. Método: estudo metodológico, com triangulação de dados, envolvendo um total de 43 participantes, sendo oito juízes para a validação de conteúdo e aparente do instrumento, utilizando-se a técnica Delphi, e para a validação semântica outros 35 profissionais da equipe cirúrgica de um hospital público do Distrito Federal, Brasil. Foi aplicado o coeficiente de confiabilidade ao instrumento. Resultados: o instrumento alcançou índice de validade de conteúdo geral de 0,9 e concordância interavaliadores de 1. O coeficiente total do alfa de Cronbach foi de 0,86, e a média dos escores das dimensões obteve notas elevadas. Conclusão: o instrumento apresentou validade nos três critérios estudados e confiabilidade para ser aplicado em futuros estudos que avaliem a segurança cirúrgica na cesárea.

Abstract 259: Pre-Procedure Checklist and Morning Huddle as Part of Patient Evaluation for Cardiac Catheterisation

Background: World Health Organization (WHO) Surgical Safety Checklist had a significant impact on surgical outcomes(1). In 2009, The United Kingdom National Patient Safety Agency required the use of this checklist(2). A pre procedure checklist for central venous line placements was one of the first commonly used checklists, and since then, the concept has been expanded to include venous thromboembolism prophylaxis, patient discharge, and many more(3). In 2016, Society of Cardiovascular Angiography and Interventions (SCAI) published a best practices consensus statement Update, which included a pre-procedure checklist for cardiac catheterizations(4). Objectives: The goals of the project were two-fold. First, to formalize the pre-procedure evaluation of patients referred to the cardiac catheterization laboratory, and second, to introduce a ‘Morning Huddle’ for all team members. The huddle is directed by a physician and includes a brief patient history and procedural plan to ensure everyone has a clear understanding of the procedure indication, patient specific risks, and procedural equipment needed. It would also provide an opportunity for group questions or to raise concerns. Methods: Safety Attitudes Questionnaire (SAQ) was used with permission from University of Texas Health Science Center at Houston, to assess the attitudes towards safety of the staff working at the cardiac catheterization laboratory, as well as the general cardiology fellows. Cardiology fellows were provided with pre-catheterization checklist, adapted from the SCAI best practices consensus statement Update, as well as an outline for the format of the ‘Morning Huddle’. Results: The total number of responses obtained were 23. The survey revealed that the majority of the staff felt that the physicians and nurses worked in a well-coordinated team (95.7%, 22 of 23). Almost 26% (6 of 23) of the staff interviewed reported difficulty in speaking up when a problem was perceived. Communication breakdown was not noted to be a problem by the majority interviewed, although a small percentage did disagree (26%, 6 of 23). Conclusions: Although the survey was overwhelmingly positive at baseline, room for improvement was noted. It is anticipated that the intervention will allow the staff an opportunity to speak up when a problem is perceived, and improve communication, by empowering the team during the ‘Morning Huddle’. Our overarching goal is to improve the safety climate in the catheterization laboratory.

Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway.

We hypothesize that high-quality implementation of the World Health Organization's Surgical Safety Checklist (SSC) will lead to improved care processes and subsequently reduction of peri- and postoperative complications. Implementation of the SSC was associated with robust reduction in morbidity and length of in-hospital stay in a stepped wedge cluster randomized controlled trial conducted in 2 Norwegian hospitals. Further investigation of precisely how the SSC improves care processes and subsequently patient outcomes is needed to understand the causal mechanisms of improvement. Care process metrics are reported from one of our earlier trial hospitals. Primary outcomes were in-hospital complications and care process metrics, e.g., patient warming and antibiotics. Secondary outcome was quality of SSC implementation. Analyses include Pearson's exact χ test and binary logistic regression. A total of 3702 procedures (1398 control vs. 2304 intervention procedures) were analyzed. High-quality SSC implementation (all 3 checklist parts) improved processes and outcomes of care. Use of forced air warming blankets increased from 35.3% to 42.4% (P < 0.001). Antibiotic administration postincision decreased from 12.5% to 9.8%, antibiotic administration preincision increased from 54.5% to 63.1%, and nonadministration of antibiotics decreased from 33.0% to 27.1%. Surgical infections decreased from 7.4% (104/1398) to 3.6% (P < 0.001). Adjusted SSC effect on surgical infections resulted in an odds ratio (OR) of 0.52 (95% confidence interval (CI): 0.38-0.72) for intervention procedures, 0.54 (95% CI: 0.37-0.79) for antibiotics provided before incision, and 0.24 (95% CI: 0.11-0.52) when using forced air warming blankets. Blood transfusion costs were reduced by 40% with the use of the SSC. When implemented well, the SSC improved operating room care processes; subsequently, high-quality SSC implementation and improved care processes led to better patient outcomes.

Tracheotomy-Related Deaths.

Tracheotomies are frequently performed on ventilated patients in intensive care and sometimes lead to fatal complications. In this article, we discuss the causes and frequency of death associated with open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) on the basis of a review of the pertinent literature. We systematically searched the PubMed, EMBASE, and Cochrane Library databases and the Karlsruhe Virtual Catalog for publications (1990-2015) on tracheotomy-related deaths in adults, using the search terms "tracheotomy" and "tracheostomy." 39 relevant dissertations were included in the analysis as well. 109 publications were included. Of the 25 056 tracheotomies described, there were 16 827 PDTs and 7934 OSTs; for 295 tracheotomies, the technique used was not stated. 352 deaths were reported, including 113 in patients treated with PDT, 49 in those treated with OST, and 190 deaths related to a tracheotomy without specification of the method used. The frequency of death among patients with OST and those treated with PDT was similar: 0.62% for OST (95% confidence interval [0.47; 0.82]) and 0.67% for PDT ([0.56; 0.81]). The most common causes of death and their frequencies, as a percentage of all tracheotomies, were hemorrhage (OST: 0.26% [0.17; 0.40], PDT: 0.26% [0.19; 0.35]), loss of airway (OST: 0.21% [0.13; 0.34], PDT: 0.20% [0.14; 0.28]), and false passage (OST: 0.11% [0.06; 0.22], PDT: 0.20% [KI 0.15; 0.29]). Bias in the data cannot be excluded, as these were not epidemiologic data and the documentation was found to be incomplete. The likelihood of a fatal complication seems to be the same with both tracheotomy techniques as far as can be determined from the available evidence. Tracheotomy-related deaths can be avoided in several ways: by thorough training under the leadership of experienced physicians, by the use of the World Health Organization's Surgical Safety Checklist regardless of where the tracheotomy is performed, and by the continuous vigilance of nursing staff.

Avaliação da segurança do paciente em cirurgia cardíaca de um hospital público

Objetivo: Avaliar itens de segurança na cirurgia cardíaca em pacientes de um hospital público. Método: Estudo descritivo e transversal. A coletade dados, desenvolvida em 2012, foi realizada em uma instituição hospitalar pública estadual, onde foram observadas 30 cirurgias cardíacas por meio deum roteiro embasado nas 3 fases do checklist de cirurgia segura da Organização Mundial da Saúde (OMS), com alternativas descritas como “em conformidade”e “em não conformidade”. Resultados: Os resultados de não conformidade corresponderam a 56% dos casos antes da indução anestésica,57% antes do procedimento e 75% na saída da sala de cirurgia. Conclusão: O checklist da OMS se faz necessário, porém, o treinamento profissional e aeducação permanente constituem a linha mestra para a formação de uma equipe de saúde crítica e consciente do seu papel na segurança dos pacientes.

Validating Obstetric Emergency Checklists using Simulation: A Randomized Controlled Trial.

Background The World Health Organization's Surgical Safety Checklist has demonstrated significant reduction in surgical morbidity. The American Congress of Obstetricians and Gynecologists District II Safe Motherhood Initiative (SMI) safety bundles include eclampsia and postpartum hemorrhage (PPH) checklists. Objective To determine whether use of the SMI checklists during simulated obstetric emergencies improved completion of critical actions and to elicit feedback to facilitate checklist revision. Study Design During this randomized controlled trial, teams were assigned to use a checklist during one of two emergencies: eclampsia and PPH. Raters scored teams on critical step completion. Feedback was elicited through structured debriefing. Results In total, 30 teams completed 60 scenarios. For eclampsia, trends toward higher completion were noted for blood pressure and airway management. For PPH, trends toward higher completion rates were noted for PPH stage assessment and fundal massage. Feedback resulted in substantial checklist revision. Participants were enthusiastic about using checklists in a clinical emergency. Conclusion Despite trends toward higher rates of completion of critical tasks, teams using checklists did not approach 100% task completion. Teams were interested in the application of checklists and provided feedback necessary to substantially revise the checklists. Intensive implementation planning and training in use of the revised checklists will result in improved patient outcomes.

Does a novel method of delivering the safe surgical checklist improve compliance? A closed loop audit

BackgroundIn February 2010, the UK National Patient Safety Agency set a mandate that the World Health Organisation's Surgical Safety Checklist (SSC) should be completed for every surgical patient within the NHS in a bid to improve surgical safety. However since its introduction, there have been issues with checklist compliance, staff engagement and surgical serious incidents continue. AimsThis study seeks to explore if an unavoidable pre-recorded audio delivery of the SSC improves compliance and staff engagement with the checklist. MethodsThe performance of the time-out and sign-out sections of the SSC were observed in three phases: standard practice, audio prompt and full audio delivery. Two researchers visited operating theatres throughout a three-week period. The outcome measures were occurrence of time-out/sign-out, completion of checklist, and presence, and engagement of staff during checklist administration. Staff feedback on the process was also sought. ResultsObservation of time-out and sign-out was undertaken for 92 procedures. Time-out and sign-out were performed for 100% of the procedures when using full audio delivery of the SSC, an improvement on findings during the standard practice phase (time out- 97.4%, sign out- 86.8%). The compliance with completion of checklist items also improved with audio delivery of the SSC. However, the presence of all key staff and active participation of team members with the checklist was unaffected by the mode of delivery. Team members' self-reported engagement did not significantly vary across the different practices. ConclusionThe intervention seems to improve rate of checklist completion, particularly signout. It also brought more consistency on the questions read out during checklist administration. It doesn't necessarily ensure all key staff are present neither does it significantly improve staff engagement in the process.