Surgical safety checklist: implementation in an ambulatory surgical facility

Abstract

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...

Application of a modified surgical safety checklist: User beware!

“…It is of interest, therefore, that Morgan et al achieved\ 10% verbalization of new checklist items, and 21 items were verbalized\ 33% of the time in their study. 3 Perhaps this result reflects the relative limitations of perioperative communication skills possessed by healthcare providers. According to Davies and Helmreich, 9 recurrent practice of effective communication is essential to integrate and augment the obligatory human factors that influence outcomes in healthcare.…”

“…In their discussion, Morgan et al mention how pilot testing the ''initial adaptation of the checklist'' might have identified, at an earlier point in time, the inconsistent degree with which added items were verbalized, permitting possible adjustments to the SSC. 3 Indeed, such an iterative process -as alluded to by the authors -was described by Weiser et al in relation to the successful modifications and implementation of the initial WHO Surgical Safety Checklist. 14 Thus, one difference in checklist development methodologies between the current work presented by Morgan et al and the efforts of Weiser et al was that of a ''2 nd Validation Stage (Pilot)'' employed in the latter study.…”

“…14 Thus, one difference in checklist development methodologies between the current work presented by Morgan et al and the efforts of Weiser et al was that of a ''2 nd Validation Stage (Pilot)'' employed in the latter study. 14 Finally, the fact that the ''big ticket'' items (such as correct patient, correct operation, correct side, and allergy identification) in Morgan et al's study were discussed in[ 90% of cases 3 highlights the strides made with specific safety-oriented behaviours in the last decade. These behaviours are a marker for a 'shift to the right' in a progressively improving safety culture.…”

“…2 D'autres auteurs ont étudié l'impact de modifications apportées à la LCSC afin de l'adapter à différents contextes cliniques. C'est le cas de Morgan et coll., dont l'étude, « La liste de contrôle pour la sécurité chirurgicale et sa mise en oeuvre dans un centre de chirurgie ambulatoire », 3 est publiée dans ce numéro du Journal.…”

“…ont obtenu \ 10 % de verbalisation des nouveaux éléments de la liste de contrôle, et que 21 éléments ont été verbalisés \ 33 % du temps dans leur étude. 3 Ce résultat reflète peut-être les limites relatives des compétences de communication périopératoire des divers fournisseurs de soins de santé. Selon Davies et Helmreich, 9 la pratique récurrente d'une communication efficace est essentielle si l'on souhaite intégrer et étendre les facteurs humains incontournables qui influencent les devenirs des patients dans les soins de santé.…”