Practical challenges of introducing WHO surgical checklist: UK pilot experience

Vats, Amit; Vincent, Charles; Nagpal, Kamal; Davies, Rachel; Darzi, Ara; Moorthy, Krishna

doi:10.1136/bmj.b5433

Cited by 274 publications

(273 citation statements)

References 5 publications

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“…[11,16,17] Our key factors were time-related issues (timing and time-consuming) and a lack of buyin from team members, which were in keeping with other studies. With numerous identified factors, Treadwell et al [18] attempted to group barriers into the following four categories: confusion regarding the proper SSCL; pragmatic changes to efficient workflow; access to resources; and individual staff beliefs and attitudes.…”

Section: Researchsupporting

confidence: 84%

“…This is in contrast to other studies, where both of these consistently appear as major factors. [16][17][18] There was a perception by the majority of all the respondents that the SSCL was supported by nurses (62.5%), anaesthetists (70.1%) and management (68.5%). This was in contrast to the perception of support by surgeons in only 45.1% of respondents.…”

Section: Researchmentioning

confidence: 99%

“…We propose some recommendations similar to those of Vats et al [17] to facilitate the use of the WHO SSCL in our context. There needs to be widespread training in the use of the SSCL, including adaptation of the checklist to make it fit for purpose in the setting.…”

Section: Recommendationsmentioning

confidence: 99%

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An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

Verwey

Gopalan

2018

S Afr Med J

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Section: Researchsupporting

confidence: 84%

Section: Researchmentioning

confidence: 99%

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An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

Verwey

Gopalan

2018

S Afr Med J

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“…33,34 In this study, several factors may have contributed to the low compliance within certain areas of the SSC and the failure to use the checklist to improve the primary and secondary outcomes. For a checklist to be effective, users at the ''sharp end'' must appreciate its value.…”

Section: Discussionmentioning

confidence: 94%

“…Similar to the comments of Vats et al, some items on the SSC were simply not relevant to cases in an ambulatory facility and were therefore ignored. 33 Another potential confounding factor in the lack of effective SSC implementation was the fact that the surgeons involved in the study were not all based primarily at our centre. They would therefore have been exposed to a different checklist at another institution and may not have recognized the differences between their home-based hospital SSC and our ambulatory facility SSC.…”

Section: Discussionmentioning

confidence: 99%

Surgical safety checklist: implementation in an ambulatory surgical facility

Morgan

Cunningham

Mitra

et al. 2013

Can J Anesth/J Can Anesth

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Purpose In 2007, the World Health Organization created a Surgical Safety Checklist (SSC) that encompassed a simple set of surgical safety standards. The threefold purpose of this study was to add ambulatory-specific items to the SSC, to introduce the items into an ambulatory surgical facility, and to determine if patient outcomes regarding postoperative pain and nausea/vomiting improved following implementation. In addition, safety attitudes, antibiotic timing, regional anesthesia/nerve blocks, preemptive pain medications, prophylactic antiemetics, length of stay, and hospital admission were also assessed.Methods After Research Ethics Board approval, staff complete a Safety Attitudes Questionnaire. Seven items were added to the SSC. Data were then collected on 180 surgical cases before SSC implementation and 195 cases following implementation. Compliance with each section of the SSC was assessed. Results On postoperative day one, the median (97.5% confidence interval [CI]) difference between pre-and postimplementation pain scores was 0.5 (97.5% CI, 0 to 1; P = 0.13), and the median difference in the rate of postdischarge nausea/vomiting was -8.4% (97.5% CI, -17.9 to 1.1; P = 0.06). There was no improvement in safety attitudes or any of the secondary outcomes, with the exception of the use of preemptive pain medications. Compliance with the three sections of the checklist, i.e., BRIEFING, TIME OUT, and DEBRIEFING was 99.49%, 97.95%, and 96.92%, respectively. There was low compliance in verbalization of the added ''ambulatory-specific items''. Conclusion Potential reasons for lack of uptake and integration include poor ''user'' buy-in, an overly lengthy checklist, and lack of prioritization of ambulatory-specific items. A shortened SSC was developed based on the results of this study. This trial was registered at ClinicalTrials.gov ID: NCT00934310.Author contributions Pamela J. Morgan was involved in the acquisition of funding for this study. Pamela J. Morgan Lisa Cunningham, Wei Wu, Victoria Noguera, and John Semple were involved in the conception and design of the study. Lisa Cunningham, Sohini Mitra, Natalie Wong, and Mary Li were involved in the acquisition of data for the study. Pamela J. Morgan was involved in the interpretation of the data. Pamela J. Morgan, Wei Wu, and Mary Li analyzed the data. Pamela J. Morgan, Lisa Cunningham, and Mary Li were involved in drafting the article. Sohini Mitra, Natalie Wong, Wei Wu, Victoria Noguera, and John Semple were involved in the critical revision of the article. Résumé Objectif En 2007, l'Organisation mondiale de la Sante´a cre´e´une Liste de contrôle de la se´curite´chirurgicale (LCSC) couvrant un ensemble simple de normes de se´curite´pour la chirurgie. L'objectif triple de cette e´tude e´tait d'ajouter des e´le´ments spe´cifiques au contexte ambulatoire a`la LCSC, d'introduire ces e´le´ments dans un centre de chirurgie ambulatoire, et de de´terminer si les devenirs des patients en matie`re de douleur et de nause´es et vomissements postope´ratoires e´taien...

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Sustainability and Long-term Effectiveness of the WHO Surgical Safety Checklist Combined With Pulse Oximetry in a Resource-Limited Setting

Kim¹,

Kwakye

Kwok

et al. 2015

JAMA Surg

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Sustained use of the checklist was observed with continued improvements in process measures and reductions in 30-day surgical complications almost 2 years after a structured implementation effort that demonstrated marked, short-term reductions in harm. The sustained effect occurred despite the absence of continued oversight by the research team, indicating the important role that local leadership and local champions play in the success of quality improvement initiatives, especially in resource-limited settings.

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Practical challenges of introducing WHO surgical checklist: UK pilot experience

Abstract: The WHO checklist has the potential to reduce preventable adverse events in surgery. But A Vats and colleagues’ experience suggests that a careful and rigorous implementation plan is required to ensure that the checklist is used routinely and correctly

Cited by 274 publications

References 5 publications

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

Surgical safety checklist: implementation in an ambulatory surgical facility

Sustainability and Long-term Effectiveness of the WHO Surgical Safety Checklist Combined With Pulse Oximetry in a Resource-Limited Setting

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