Effective Surgical Safety Checklist Implementation Conley, Dante M., MD; Singer, Sara J., PhD, MBA; Edmondson, Lizabeth, BA ...
Journal of the American College of Surgeons,
05/2011, Letnik:
212, Številka:
5
Journal Article
Recenzirano
Background Research suggests that surgical safety checklists can reduce mortality and other postoperative complications. The real world impact of surgical safety checklists on patient outcomes, ...however, depends on the effectiveness of hospitals' implementation processes. Study Design We studied implementation processes in 5 Washington State hospitals by conducting semistructured interviews with implementation leaders and surgeons from September to December 2009. Interviews were transcribed, analyzed, and compared with findings from previous implementation research to identify factors that distinguish effective implementation. Results Qualitative analysis suggested that effectiveness hinges on the ability of implementation leaders to persuasively explain why and adaptively show how to use the checklist. Coordinated efforts to explain why the checklist is being implemented and extensive education regarding its use resulted in buy-in among surgical staff and thorough checklist use. When implementation leaders did not explain why or show how the checklist should be used, staff neither understood the rationale behind implementation nor were they adequately prepared to use the checklist, leading to frustration, disinterest, and eventual abandonment despite a hospital-wide mandate. Conclusions The impact of surgical safety checklists on patient outcomes is likely to vary with the effectiveness of each hospital's implementation process. Further research is needed to confirm these findings and reveal additional factors supportive of checklist implementation.
Background Because operating room crises are rare events, failure to adhere to critical management steps is common. We sought to develop and pilot a tool to improve adherence to lifesaving measures ...during operating room crises. Study Design We identified 12 of the most frequently occurring operating room crises and corresponding evidence-based metrics of essential care for each (46 total process measures). We developed checklists for each crisis based on a previously defined method, which included literature review, multidisciplinary expert consultation, and simulation. After development, 2 operating room teams (11 participants) were each exposed to 8 simulations with random assignment to checklist use or working from memory alone. Each team managed 4 simulations with a checklist available and 4 without. One of the primary outcomes measured through video review was failure to adhere to essential processes of care. Participants were surveyed for perceptions of checklist use and realism of the scenarios. Results Checklist use resulted in a 6-fold reduction in failure of adherence to critical steps in management for 8 scenarios with 2 pilot teams. These results held in multivariate analysis accounting for clustering within teams and adjusting for learning or fatigue effects (11 of 46 failures without the checklist vs 2 of 46 failures with the checklist; adjusted relative risk = 0.15, 95% CI, 0.04–0.60; p = 0.007). All participants rated the overall quality of the checklists and scenarios to be higher than average or excellent. Conclusions Checklist use can improve safety and management in operating room crises. These findings warrant broader evaluation, including in clinical settings.
Abstract Background Studies show that using surgical safety checklists (SSCs) reduces complications. Many believe SSCs accomplish this by enhancing teamwork, but evidence is limited. Our study seeks ...to relate teamwork to checklist performance, understand how they relate, and conditions affect this relationship. Study Design Using 2 validated tools for observing and coaching operating room teams, we evaluated the association between checklist performance with surgeon buy-in and four domains of surgical teamwork: clinical leadership, communication, coordination, and respect. Hospital staff in 10 South Carolina hospitals observed 207 procedures between April 2011 and January 2013. We calculated levels of checklist performance, buy-in, and measures of teamwork and evaluated their relationship, controlling for patient and case characteristics. Results Few teams completed most or all SSC items. Teams more often completed items considered procedural “checks” than conversation “prompts.” Surgeon buy-in, clinical leadership, communication, a summary measure of teamwork overall, and observers’ teamwork ratings positively related to overall checklist completion (multivariable model estimates from 0.04, p<0.05 for communication to 0.17, p<0.01 for surgeon buy-in). All measures of teamwork and surgeon buy-in related positively to completing more conversation prompts, while none related significantly to procedural checks (estimates from 0.10, p<0.01 for communication to 0.27, p<0.001 for surgeon buy-in). Patient age was significantly associated with completing the checklist and prompts (p<0.05); only case duration was positively associated with performing more checks (p<0.10). Conclusions Surgeon buy-in and surgical teamwork characterized by shared clinical leadership, open communication, active coordination, and mutual respect were critical in prompting case-related conversations, but not to completing procedural checks. Findings highlight the importance of surgeon engagement and high-quality, consistent teamwork for promoting checklist use and ensuring a safe surgical environment.
Structured Abstract Background Prior research suggests surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and ...communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room. Study Design As part of the Safe Surgery 2015 initiative to implement SSCs in South Carolina hospitals, we administered a validated survey designed to measure perception of multiple dimensions of perioperative safety among clinical operating room personnel before and after implementation of an SSC. Results Thirteen hospitals administered baseline and follow-up surveys, separated by one to two years. Response rates were 48.4% at baseline (929/1921) and 42.7% (815/1909) at follow-up. Results suggest improvement in five of the five dimensions of teamwork (relative percent improvement ranged from +2.9% for coordination to +11.9% for communication). These were significant after adjusting for respondent characteristics, hospital fixed-effects, and multiple comparisons, and clustering robust standard errors by hospital (all p<0.05). More than half of respondents (54.1%) said their surgical teams always used checklists effectively; 73.6% said checklists had averted problems or complications. Conclusions A large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.
