Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis

Sotto, Kenji T.; Burian, Barbara K.; Brindle, Mary

doi:10.1016/j.jamcollsurg.2021.08.692

Cited by 26 publications

(28 citation statements)

References 49 publications

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“…A recent systematic review and meta-analysis done by Sotto and colleagues (2021) reported that team members found the SCCL to increase situational awareness by facilitating the exchange of information regarding the patient's history, risk and required procedure. This review also found overwhelmingly positive reports on the effect of the SSCL on teamwork, team dynamics and communication (Sotto et al, 2021).…”

Section: Contributions and Impactmentioning

confidence: 89%

“…However, other studies showed no association between checklist use and similar outcomes (Urbach et al, 2014;Gama et al, 2019). While the results are mixed regarding the effectiveness of the SSCL at improving clinical outcomes, there is a general agreement that the SSCL improves the perception of teamwork, communication, situational awareness, and safety climate in the OR (Haynes et al, 2011, Khoshbin et al, 2009, Sotto et al, 2021 Copyright 2022 by Human Factors and Ergonomics Society. All rights reserved.…”

Section: Introductionmentioning

confidence: 99%

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Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery

Evangelista

Ng³

et al. 2022

Proceedings of the International Symposium on Human Factors and

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The Surgical Safety Checklist (SSCL) is a widely implemented intervention; however, limited studies have explored system factors that impact adherence to proper checklist completion. Using an audio-visual recording technology called the Operating Room Blackbox (ORBB), the goal of this study was to characterize the level of checklist completion and identify work system factors that impact the use of the SSCL in general laparoscopic surgery. Thirty-six cases captured by the ORBB in a hospital in Toronto, Ontario were reviewed using an SSCL audit tool to collect data on item-level adherence. The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model was applied to the observation notes from the ORBB recordings to identify work system factors influencing checklist use. On average, across all 36 cases, 8 of the 29 checklist items were completed (30.1%), with debriefing being completed most frequently of the 3 checklist sections. Of the 29 checklist items, commonly completed items were: patient concerns addressed, surgical counts complete, and procedure name, while items in the timeout section were completed the least. Notably, factors related to person (e.g., confirmation of patient information amongst surgical team) and tools and technology (e.g., use of checklist in combination with patient chart) were identified as facilitators to checklist use, while factors relating to tasks (e.g., redundancy of checklist items with existing workflow), tools and technology (e.g., some checklist items not applicable to some procedures), organization (e.g, timing of checklist items and absence of team member), and internal environment (e.g., music volume in the OR) were identified as potential barriers to checklist use. By understanding how system factors contribute to checklist use and item-level adherence, we can identify ways to improve the checklist to meet the needs of the OR team and enhance integration of the SSCL into existing workflows.

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Section: Contributions and Impactmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery

Evangelista

Ng³

et al. 2022

Proceedings of the International Symposium on Human Factors and

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“…When used well, the WHO SSC has a demonstrated association with the clinical outcomes addressed within it but is not associated outcomes that are not directly addressed (eg, deep vein thrombosis prophylaxis). 12 With this in mind, the ERAS SSC was designed to ensure that discussions addressing specific issues important to a patient's recovery are discussed at 3 defined, critical points in perioperative care. This new checklist has introduced new elements critical to patient safety and optimal recovery.…”

Section: Discussionmentioning

confidence: 99%

“…11 Both tools have demonstrated consistent associations with improved surgical safety and outcomes, particularly within colorectal and gynecologic surgery, where ERAS is best-studied. [12][13][14] ERAS guidelines often consist of upwards of 20 items designed to be implemented as a care bundle. The level of adherence correlates with outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

et al. 2023

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ImportanceEnhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively.ObjectiveTo integrate the 2 tools to facilitate key perioperative decision-making.Evidence ReviewSnowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022.FindingsRound 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs.Conclusions and RelevanceThe SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.

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Modifications of the World Health Organization’s Surgical Safety Checklist—Ways Forward to Ensure Sustainable Implementation

Haugen

2023

JAMA Netw Open

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Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis

Cited by 26 publications

References 49 publications

Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery

Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

Modifications of the World Health Organization’s Surgical Safety Checklist—Ways Forward to Ensure Sustainable Implementation

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