Effect of implementation of a surgical safety checklist on perioperative and postoperative complications at an academic institution in North America

Abstract

Objective To evaluate the efficacy of a surgical safety checklist (SSC) in reducing perioperative and postoperative complications. Study design Before‐and‐after intervention study. Animals Client‐owned dogs (n = 633) and cats (n = 44). Methods Consecutive surgeries were enrolled in the study. The “before” phase consisted of 267 surgeries performed without an SSC (SSC−) followed by 75 SSC− surgeries in which a trained observer was in the operating room to detect possible complications. An SSC was then implemented in the operating rooms during 1 week. The “after” phase consisted of 58 surgeries in which a safety checklist (SSC+) and an observer were used and 277 SSC+ surgeries without an observer. Complications were prospectively recorded when witnessed by the observer, and all other perioperative complications were retrospectively recorded from veterinary records and client telephone communication. Results There were more perioperative and postoperative complications when surgeries were performed without an SSC (140/342 [40.9%; 95% CI, 35.7%‐46.4%]) than there were when surgeries were performed with an SSC (98/335 [29.3%; 95% CI, 24.4%‐34.4%]; P = .002). Surgical checklist use, presence of an observer, American Society of Anesthesiologists score, and anesthesia time were all independently associated with the odds of complications. Conclusion Implementation of an SSC in an academic teaching hospital decreased the odds of perioperative and postoperative surgical complications. Clinical significance This study supports the use of an SSC to prevent surgical complications in veterinary teaching hospitals.

The impact of a surgical checklist on surgical outcomes in an academic institution

“…In the paper by Cray et al, a decrease in SSI was detected following commencement of the checklist. 8 Their reported prechecklist rate of SSI was 7.9%, while the prechecklist rate of SSI in our population was 2.5%. Some of the processes in place at our institution prior to commencement of the checklist may explain this low rate of SSI, potentially affecting the ability to further prevent this complication with implementation of additional preventive measures, such as a checklist.…”

“…A study focused on the effects of a SC in academic veterinary medicine 8 included 677 animals, 342 animals in the prechecklist group and 335 animals in the postchecklist group. 8 That study concluded that implementation of a SC decreased the odds of perioperative and postoperative surgical complications from 40.9% to 29.3%. This change included a reduction in the rate of postoperative SSIs from 7.9% to 3.0%.…”

Staff attitudes to and compliance with the use of a surgical safety checklist

“…, Cray et al . ). The checklist used in our hospital was a modified version of the WHO checklist and was designed by two individuals.…”

Use of a surgical safety checklist after implementation in an academic veterinary hospital

“…11,12,13 Veterinary literature related to the application of SSC has largely focused on its influence on animal morbidity rather than on implementation strategies. [14][15][16][17][18] Improved postoperative outcomes have been documented after implementation and consistent use of SSC in clinical settings. [14][15][16] However, the inconsistent uptake of SSC documented in the human literature justifies exploration of implementation strategies in veterinary medicine.…”

“…[14][15][16][17][18] Improved postoperative outcomes have been documented after implementation and consistent use of SSC in clinical settings. [14][15][16] However, the inconsistent uptake of SSC documented in the human literature justifies exploration of implementation strategies in veterinary medicine. 19 Barriers identified in the human research may prove a useful benchmark for effective implementation of SSC, but it is hypothesized that veterinary organizational and cultural differences may nuance the experience.…”