Evaluation of a Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologists to Reduce Failures in Communication

Lingard, Lorelei; Regehr, Glenn; Orser, Beverley A.; Reznick, Richard K.; Baker, G. Ross; Doran, Diane; Espin, Sherry; Bohnen, Jordan D.; Whyte, Sarah

doi:10.1001/archsurg.2007.21

Cited by 525 publications

(362 citation statements)

References 18 publications

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“…Completion of the sign-in, time-out, and sign-out checklists require a formal pause in patient care with all team members present and communicating. Preoperative team introductions and briefings have been shown to also significantly improve patient safety, team morale, and specific clinical outcomes [16]- [18]. Ali et al conducted a questionnaire study among 37 surgical staff members and reported that 89% of staff believed the WHO safety checklist improved communication and 97% thought the pause highlighted potential patient problems [19].…”

Section: Discussionmentioning

confidence: 99%

The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

Lau¹,

Chamberlain²

2016

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Background: The incidence of in-hospital adverse events is about 10%, with a majority of these related to surgery, and nearly half considered preventable events. In attempts to improve patient safety, the World Health Organization (WHO) developed a checklist to be used at critical perioperative moments. This meta-analysis examines the impact of the WHO surgical safety checklist (SSC) on various patient outcomes. Methods: A comprehensive search of all published studies assessing the use of the WHO SSC in patients undergoing surgery was conducted. Studies using the WHO SSC in any surgical setting, with pre-implementation and post-implementation outcome data were included. The incidence of patient outcomes (total complications, surgical site infections, unplanned return to the operating room (OR) within 30 days, and overall mortality) and adherence to safety measures were analyzed. Results: 10 studies involving 51,125 patients (27,490 prior to implementation and 23,635 after implementation of the WHO SSC) were analyzed. The implementation of the WHO SSC significantly reduced the risk of total complications by 37.9%, surgical site infections by 45.5%, unplanned return to OR by 32.1%, and mortality by 15.3%. Increased adherence to safety measures including airway evaluation, use of pulse oximetry, prophylactic antibiotics when necessary, confirmation of patient name and surgical site, and sponge count was also observed. Conclusions: The use of the WHO SSC is associated with a significant reduction in post-operative complication rates and mortality. The WHO SSC is a valuable tool that should be universally implemented in all surgical centers and utilized in all surgical patients.

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Section: Discussionmentioning

confidence: 99%

The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

Lau¹,

Chamberlain²

2016

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“…Certain cultural barriers may also play a significant role, such as the presence of hierarchies that can hinder open communication and the related ability to ''speak up'' with concerns, as related in the TO literature. Where these cultural barriers highlight historical descriptions of the doctor-nurse relationship and its effect on patient care, [19][20][21] Critical Conversations provide an opportunity to improve such interdisciplinary relationships by providing a shared tool for direct communication.…”

Section: Discussionmentioning

confidence: 99%

Critical conversations: A call for a nonprocedural “time out”

Sehgal

Fox

Sharpe

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Communication failures are an ongoing threat to patient safety. Procedural “time outs” were developed as a method to enhance communication and mitigate patient harm. Nonprocedural settings generate equal risks for communication failure, yet lack a similar communication tool or practice that can be applied, particularly with a patient‐driven focus.INNOVATION:Rapidly changing clinical states and care plans are common in the hospital setting, placing patients at risk for adverse events. Certain junctures allow for the highest potential of patient harm—at the time of admission, at a change in clinical condition, and at the time of discharge. Direct communication among healthcare providers at these junctures, which we have dubbed Critical Conversations, can provide an opportunity to clarify plans of care, address or anticipate concerns, and foster greater teamwork. Information exchanged during Critical Conversations includes a combination of checklist‐type items and more open‐ended questions but they ultimately create a structure and expectation for communication.LESSONS LEARNED:Integration of Critical Conversations into practice requires provider education and buy‐in, as well as expectations for them to occur. Monitoring adherence, capturing stories of success, and demonstrating effectiveness may enhance implementation and continuous improvement in the process.CONCLUSIONS:Communication tools designed to reduce the likelihood of patient harm remain a focus of patient safety efforts. Critical Conversations are an innovative communication tool, intervention, and policy that potentially limits communication failures at critical junctures to ensure high quality and safe patient care. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

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“…Studies showed improved overall communication as a result of both increased communication [56] and reduced failures of communication [45]. The sign-in, time-out, and sign-out periods prompted by a surgical checklist introduced in a pediatric hospital facilitated communication among operating room staff and, subsequently, identification of ''near miss'' situations [56].…”

Section: Do Safety Checklists Improve Quality Of Surgical Care?mentioning

confidence: 99%

“…The sign-in, time-out, and sign-out periods prompted by a surgical checklist introduced in a pediatric hospital facilitated communication among operating room staff and, subsequently, identification of ''near miss'' situations [56]. The implementation of a surgical checklist in general surgery reduced the mean number of communication failures per procedure from 3.95 to 1.31 as well as reduced the number of communication failures associated with visible negative consequences by 64% [45]. Checklists also enhanced processes of care such as appropriate use of prophylactic antibiotics to reduce surgical site infection [22].…”

Section: Do Safety Checklists Improve Quality Of Surgical Care?mentioning

confidence: 99%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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Evaluation of a Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologists to Reduce Failures in Communication

Abstract: Interprofessional checklist briefings reduced the number of communication failures and promoted proactive and collaborative team communication.

Cited by 525 publications

References 18 publications

The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

Critical conversations: A call for a nonprocedural “time out”

The Use of Three Strategies to Improve Quality of Care at a National Level

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