Utility of a Device Briefing Tool to Improve Surgical Safety

Etheridge, James C; Moyal‐Smith, Rachel; Lim, Shu Rong; Yong, Tze Tein; Tan, Hiang Khoon; Sonnay, Yves; Brindle, Mary; Lim, Christine; Rothbard, Sarah; Murray, Eleanor; Havens, Joaquim M.

doi:10.1016/j.jss.2022.07.018

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…A “Device Briefing Tool” was integrated into the checklist to prompt team discussion around new and complex devices. This Device Briefing Tool had been pilot tested earlier in the year at SGH and had demonstrated a high degree of utility and feasibility 13 . To address communication openness, team introductions and a statement made by the surgeon to speak up if there are any concerns were added to the time‐out.…”

Section: Discussionmentioning

confidence: 99%

“…This Device Briefing Tool had been pilot tested earlier in the year at SGH and had demonstrated a high degree of utility and feasibility. 13 To address communication openness, team introductions and a statement made by the surgeon to speak up if there are any concerns were added to the time-out. We also redeveloped the checklist as a poster that could be viewed by everyone in the room.…”

Section: Discussionmentioning

confidence: 99%

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Creating a high‐performance surgical safety checklist: A multimodal evaluation plan to reinvigorate the checklist

Moyal‐Smith

Etheridge

Lim

et al. 2022

Evaluation Clinical Practice

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Rationale, Aims, and Objectives: The WHO Surgical Safety Checklist is a communication tool designed to improve surgical safety processes and enhance teamwork. It has been widely adopted since its introduction over ten years ago.As surgical safety needs evolve, organizations should periodically review and update their checklists. A holistic evaluation of the checklist in the context of an organization is the first step to making informed updates. In this article, we describe a comprehensive but feasible strategy for checklist evaluation which we developed and implemented as part of a surgical safety initiative in a high-performing center.Methods: A three-part evaluation plan was developed and carried out by a multidisciplinary team. The evaluation included assessment of 1. Quality of care through a review of surgical safety events; 2. Safety culture through a validated survey and informal feedback; and 3. Checklist performance through direct observations and a staff survey. To prepare for re-implementation the current institutional checklist was critically evaluated and a context assessment survey was administered to surgical staff. Results:The evaluation revealed challenges in communication and teamwork, with surgical staff often perceived to be working in silos. The quality of care assessment indicated room for improvement in safety processes. Deficiencies in the safety culture measures of communication and feedback shed light on an overall lack of engagement with the checklist. Checklist performance demonstrated good adherence to the items on the checklist but limited engagement by the surgical team and minimal communication between subteams. These findings informed our revisions to the checklist and its implementation processes. Conclusions:We developed and implemented a comprehensive, scalable approach to checklist evaluation which directly informed improvements to the checklist that were tailored to the organization's current context. Organizations can apply this framework to breathe new life into their checklist and transform their safety culture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Creating a high‐performance surgical safety checklist: A multimodal evaluation plan to reinvigorate the checklist

Moyal‐Smith

Etheridge

Lim

et al. 2022

Evaluation Clinical Practice

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“…The study protocol was registered with ClinicalTrials.gov (NCT05123495). In the first phase, we piloted the Device Briefing Tool, a communication instrument designed to enhance surgical device safety, details of which have been published previously . In the second phase, we developed and tested a comprehensive approach to SSC reimplementation based on the Exploration, Preparation, Implementation, Sustainment framework .…”

Section: Methodsmentioning

confidence: 99%

“…In the first phase, we piloted the Device Briefing Tool, a communication instrument designed to enhance surgical device safety, details of which have been published previously. 24 In the second phase, we developed and tested a comprehensive approach to SSC reimplementation based on the Exploration, Preparation, Implementation, Sustainment framework. 25 We aimed to evaluate the ability of our approach to drive meaningful use of the SSC and assess the effect of reimplementation on team performance and patient safety.…”

Section: Study Design and Settingmentioning

confidence: 99%

Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist

Etheridge,

Moyal-Smith,

Yong

et al. 2024

JAMA Surg

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ImportancePatient safety interventions, like the World Health Organization Surgical Safety Checklist, require effective implementation strategies to achieve meaningful results. Institutions with underperforming checklists require evidence-based guidance for reimplementing these practices to maximize their impact on patient safety.ObjectiveTo assess the ability of a comprehensive system of safety checklist reimplementation to change behavior, enhance safety culture, and improve outcomes for surgical patients.Design, Setting, and ParticipantsThis prospective type 2 hybrid implementation-effectiveness study took place at 2 large academic referral centers in Singapore. All operations performed at either hospital were eligible for observation. Surveys were distributed to all operating room staff.InterventionThe study team developed a comprehensive surgical safety checklist reimplementation package based on the Exploration, Preparation, Implementation, Sustainment framework. Best practices from implementation science and human factors engineering were combined to redesign the checklist. The revised instrument was reimplemented in November 2021.Main Outcomes and MeasuresImplementation outcomes included penetration and fidelity. The primary effectiveness outcome was team performance, assessed by trained observers using the Oxford Non-Technical Skills (NOTECH) system before and after reimplementation. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to assess safety culture and observers tracked device-related interruptions (DRIs). Patient safety events, near-miss events, 30-day mortality, and serious complications were tracked for exploratory analyses.ResultsObservers captured 252 cases (161 baseline and 91 end point). Penetration of the checklist was excellent at both time points, but there were significant improvements in all measures of fidelity after reimplementation. Mean NOTECHS scores increased from 37.1 to 42.4 points (4.3 point adjusted increase; 95% CI, 2.9-5.7; P &lt; .001). DRIs decreased by 86.5% (95% CI, −22.1% to −97.8%; P = .03). Significant improvements were noted in 9 of 12 composite areas on culture of safety surveys. Exploratory analyses suggested reductions in patient safety events, mortality, and serious complications.Conclusions and RelevanceComprehensive reimplementation of an established checklist intervention can meaningfully improve team behavior, safety culture, patient safety, and patient outcomes. Future efforts will expand the reach of this system by testing a structured guidebook coupled with light-touch implementation guidance in a variety of settings.

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A Tutorial on Applying the Difference-in-Differences Method to Health Data

Rothbard,

Etheridge,

Murray

2023

Curr Epidemiol Rep

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Purpose of Review Difference-in-differences analyses are a useful tool for estimating group-level decisions, such as policy changes, training programs, or other non-randomized interventions, on outcomes which occur within the intervention group. However, there is little practical advice on how to apply difference-in-differences to epidemiologic and health data. Here, we provide a tutorial on applying the difference-in-differences method to health services data, targeted at epidemiologists and other biomedical researchers. Recent Findings As epidemiologists increasingly engage in policy discussions, familiarity with difference-in-differences will be increasingly important. However, much of the literature on difference-in-differences is limited to econometrics examples where the types of data and questions encountered may differ from health research. There remain limited resources for epidemiologists and other medical researchers to learn how to implement difference-in-differences analyses without first having to familiarize themselves with econometric terminology and concepts. Summary This tutorial contains synthetic data, code, and worksheets for class instruction. We provide a step-by-step description of the difference-in-differences analysis including sensitivity checks, modeling decisions, and interpretation. In addition, we supply novel guidance on modeling difference-in-differences outcomes for count or score outcomes.

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Utility of a Device Briefing Tool to Improve Surgical Safety

Cited by 4 publications

References 19 publications

Creating a high‐performance surgical safety checklist: A multimodal evaluation plan to reinvigorate the checklist

Creating a high‐performance surgical safety checklist: A multimodal evaluation plan to reinvigorate the checklist

Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist

A Tutorial on Applying the Difference-in-Differences Method to Health Data

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