Suboptimal compliance with surgical safety checklists in Colorado: A prospective observational study reveals differences between surgical specialties

Patient Safety in Surgery

Crystal Berumen¹  Fredric M Pieracci¹  Annalee W Gallagher¹  Walter L Biffl¹ 

[1] Department of Surgery, Denver Health Medical Center, 777 Bannock St., MC 0206, Denver 80204, CO, USA

关键词: Sentinel events;    Operating room;    Surgeons;    Implementation;    Observation;    Compliance;    Safety;    Surgery;    Checklist;   

Others  :  1132114
DOI  :  10.1186/s13037-014-0056-z

 received in 2014-11-24, accepted in 2014-12-29,  发布年份 2015

【 摘 要 】

Background

Surgical safety checklists (SSCs) are designed to improve team communication and consistency in care, ultimately avoiding complications. In Colorado, hospitals reported that use of SSCs was standard practice, but a statewide survey indicated that SSC use was inconsistent. The purpose of this project was to directly observe the compliance with the SSC in Colorado hospitals, through direct observation of the perioperative checklist process.

Methods

Ten hospitals participated in a quality improvement initiative. Trained team members recorded compliance with each of the components of the SSC. Data analysis was performed using a chi-squared test or ANOVA, depending on the number of categorical variables, with p < 0.05 determining statistical significance.

Results

Ten hospitals representing statewide diversity submitted 854 observations (median 98, range 24–106). 83% of cases were elective, 13% urgent, and 4% emergent/trauma. There was significant variation across hospitals in: team introductions, cessation of activity, affirming correct procedure, assessing hypothermia risk, need for beta blocker, or VTE prophylaxis. Uniformly poor compliance was observed with respect to assessment of case duration, blood loss, anesthesiologists’ concerns, or display of essential imaging. Only 71% of observers reported active participation by physicians; 9% reported that “the majority did not pay attention” and 4% reported that the team was “just going through the motions”. There were significant differences among surgical specialty groups in the majority of the elements.

Conclusion

SSCs have been implemented by the vast majority of hospitals in our state; however, compliance with SSC completion in the operating room has wide variation and is generally suboptimal. Although this study was not designed to correlate SSC compliance with outcomes, there are concerns about the risk of a sentinel event or unanticipated complication resulting from poor preparation.

【 授权许可】

   
2015 Biffl et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

【 参考文献 】

• [1]Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AHS, Dellinger EP, et al.: A surgical safety checklist to reduce morbidity and mortality in a global population. New Engl J Med 2009, 360:491-9.
• [2]Panesar SS, Cleary K, Sheikh A, Donaldson L: The WHO checklist: a global tool to prevent errors in surgery. Patient Saf Surg 2009, 3:9. BioMed Central Full Text
• [3]Pickering SP, Robertson ER, Griffin D, Hadi M, Morgan LJ, Catchpole KC, et al.: Compliance and use of the world health organization checklist in UK operating theatres. Br J Surg 2013, 100:1664-70.
• [4]Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN: Introduction of surgical safety checklists in Ontario, Canada. New Engl J Med 2014, 370:1029-38.
• [5]Hurlburt SN, Garrett J: Improving operating room safety. Patient Saf Surg 2009, 3:25. BioMed Central Full Text
• [6]Birkmeyer JD: Strategies for improving surgical quality- checklists and beyond. New Engl J Med 2010, 363:1963-5.
• [7]van Klei WA, Hoff RG, van Aarnhem EE, Simmermacher RK, Regli LP, Kappen TH, et al.: Effects of the introduction of the WHO “surgical safety checklist” on in-hospital mortality: a cohort study. Ann Surg 2012, 255:44-9.
• [8]Borchard A, Schwappach DLB, Barbir A, Bezzola P: A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. Ann Surg 2012, 256:925-33.
• [9]Bergs J, Hellings J, Cleemput I, Zurel O, De Troyer V, Van Hiel M, et al.: Systematic review and meta-analysis of the effect of the world health organization surgical safety checklist on postoperative complications. Br J Surg 2014, 101:150-8.
• [10]Haugen AS, Softeland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, et al. Effect of the World Health Organization checklist on patient outcomes: A stepped wedge cluster randomized controlled trial. Ann Surg. 2014. [Epub ahead of print].
• [11]Lembitz A, Clarke TJ: Clarifying “never events” and introducing “always events.”. Patient Saf Surg 2009, 3:26. BioMed Central Full Text
• [12]Stahel PF, Sabel AL, Victoroff MS, Varnell J, Lembitz A, Boyle DJ, et al.: Wrong-site and wrong patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences. Arch Surg 2010, 145:978-84.
• [13]Levy SM, Senter CE, Hawkins RB, Zhao JY, Doody K, Kao LS, et al.: Implementing a surgical checklist: more than checking a box. Surgery 2012, 152:331-6.
• [14]Sparks EA, Wehbe-Janek H, Johnson RL, Smythe WR, Papaconstantinou HT: Surgical safety checklist compliance: A job done poorly! J Am Coll Surg 2013, 217:867-73.
• [15]Paull DE, Mazzia LM, Izu BS, Neily J, Mills PD, Bagian JP: Predictors of successful implementation of preoperative briefings and postoperative debriefings after medical team training. Am J Surg 2009, 198:675-8.
• [16]Conley DM, Singer SJ, Edmondson L, Berry WR, Gawande AA: Effective surgical safety checklist implementation. J Am Coll Surg 2011, 212:873-9.
• [17]O’Connor P, Reddin C, O’Sullivan M, O’Duffy F, Keogh I: Surgical checklists: the human factor. Patient Saf Surg 2013, 7:14. BioMed Central Full Text
• [18]Hannam JA, Glass L, Kwon J, Windsor J, Stapelberg F, Callaghan K, et al.: A prospective, observational study of the effects of implementation strategy on compliance with a surgical safety checklist. BMJ Qual Saf 2013, 22:940-7.
• [19]Van Schoten SM, Kop V, de Blok C, Spreeuwenberg P, Groenewegen PP, Wagner C: Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: Results of a national patient safety programme in the Netherlands. BMJ Open 2014, 4:e005075.
• [20]Russ S, Rout S, Caris J, Mansell J, Davies R, Mayer E, et al. Measuring variation in use of the WHO surgical safety checklist in the operating room: A multi-center prospective cross-sectional study. J Am Coll Surg. 2014. doi:10.1016/j.jamcollsurg.2014.09.021
• [21]Johnston FM, Tergas AI, Bennett JL, Valero V III, Morrissey CK, Fader AN, et al.: Measuring briefing and checklist compliance in surgery: a tool for quality improvement. Am J Med Qual 2014, 29:491-8.
• [22]Leape LL: The checklist conundrum. New Engl J Med 2014, 370:1063-4.
• [23]Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA: Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 2010, 251:976-80.