Surgical safety checklist implementation and its impact on patient safety
DOI:
https://doi.org/10.18203/2349-2902.isj20184637Keywords:
Surgical safety checklist, MortalityAbstract
Background: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. Although surgical and anesthetic caregivers seek to deliver optimal quality in peri-operative service, surgery still carries considerable risk for the patient. WHO surgical safety checklist outlines essential standards of surgical care and has been shown to reduce complications and death associated with surgery.
Methods: Pre-intervention and post-intervention study. The effect on patient outcomes and documentation of WHO surgical safety checklist was examined. After an education programme, the checklist implementation and patient safety outcome indicators were studied.
Results: Checklist compliance increased over time. The median number of items documented was 16. After implementation of the checklist, mortality decreased from 3.13% to 2.85%. Most causes of death did not significantly differ between the implementation periods, except for multiorgan failure and major bleeding. Adjustment of the association between implementation period and outcome for all variables revealed a decreased mortality after checklist implementation.
Conclusions: Implementation of the checklist showed improved outcomes. Use of the WHO surgical safety checklist in urgent operations is feasible and should be considered. Implementation proved neither costly nor lengthy. Further research is needed to confirm these findings and reveal additional factors supportive of checklist implementation.
References
Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491-9.
World Health Organization. World Alliance for Patient Safety. WHO Guidelines for Safe Surgery. 1st ed. Geneva, Switzerland: WHO; 2008.
Khuri SF, Daley J, Henderson W. The national veterans administration surgical risk study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180:519-31.
Lingard L, Regehr G, Orser B. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg. 2008;143:12-7.
Mazzocco K, Petitti DB, Fong KT. Surgical team behaviors and patient outcomes. Am J Surg. 2009;197:678-85.
Institute for Healthcare Improvement. Surgical Safety Checklist Sprint Map. 2009. Available at http://www.ihi.org/ihi/gmaps/Surgical_Sprint_Map.aspx. Accessed 7 April 2009.
Weiser TG, Bhaynes A, Dzeikan G. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg. 2010;251:976-80.
Van Klei WA, Hoff RG, van Aarnhem EEHL. Effects of the introduction of the WHO surgical safety checklist on In-hospital mortality: a cohort study. Ann Surg. 2012;255:44-9.
Conley DM, Singer SJ, Edmondson L. Effective Surgical Safety Checklist Implementation. Elsevier. 2011;212(5)873-9.
Gagliardi AR, Straus SE, Courvoisier DS. Multiple interacting factors influence adherence, and outcomes associated with surgical safety checklists: a qualitative study PLoS One. 2014;9(9):e108585.
