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

Abstract

Objective: To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. Study design: Voluntary online survey and retrospective study. Sample population: All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. Methods: Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. Results: Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. Conclusion: The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). Clinical significance: The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.

Surgical safety checklists in UK veterinary practice: Current implementation and attitudes towards their use

“…Similar observations were noted by Menoud et al 25 . One study, based at a veterinary teaching hospital in Ontario, identified that ‘forgetting to use’ was the most frequently stated cause for SSC usage failure 26 . These veterinary studies are all small scale and single site based, with human behaviour likely influenced by individual workplace culture.…”

The case for quality improvement in veterinary medicine

“…In 1 study, despite the fact that 76% of survey respondents saw an immediate benefit to using an SSC, a complete checklist was used in only 47.7% of surgeries. 28 In a second study, 95% of survey respondents believed a complete SSC was used in every procedure-in reality, however, only 8.4% of these SSCs were completed in full. 29 These gaps demonstrate that opportunity exists to more widely and completely implement SSCs and further mitigate surgical and anesthetic risk in our patients.…”

“…Two veterinary studies demonstrated that routine use of SSC in clinical practice is unfortunately the exception, not the norm. In 1 study, despite the fact that 76% of survey respondents saw an immediate benefit to using an SSC, a complete checklist was used in only 47.7% of surgeries 28 . In a second study, 95% of survey respondents believed a complete SSC was used in every procedure—in reality, however, only 8.4% of these SSCs were completed in full 29 .…”

“…SSCs have been associated with significant reductions in major complications associated with transvenous pacemaker placement, postoperative surgical complications and wound healing, and surgical site infections in dogs and cats 25,26,27 . Most veterinary professionals support SSC use and agree that improvements in patient safety, teamwork, and communication occur following implementation 28,29 …”

“…25,26,27 Most veterinary professionals support SSC use and agree that improvements in patient safety, teamwork, and communication occur following implementation. 28,29 Despite clear evidence of the clinical and cultural benefits of SSCs, checklists are not consistently used in veterinary medicine. Two veterinary studies demonstrated that routine use of SSC in clinical practice is unfortunately the exception, not the norm.…”