Effects of the introduction of the WHO "Surgical Safety Checklist" on in-hospital mortality: a cohort study.
ABSTRACT To evaluate the effect of implementation of the WHO's Surgical Safety Checklist on mortality and to determine to what extent the potential effect was related to checklist compliance.
Marked reductions in postoperative complications after implementation of a surgical checklist have been reported. As compliance to the checklists was reported to be incomplete, it remains unclear whether the benefits obtained were through actual completion of a checklist or from an increase in overall awareness of patient safety issues.
This retrospective cohort study included 25,513 adult patients undergoing non-day case surgery in a tertiary university hospital. Hospital administrative data and electronic patient records were used to obtain data. In-hospital mortality within 30 days after surgery was the main outcome and effect estimates were adjusted for patient characteristics, surgical specialty and comorbidity.
After checklist implementation, crude mortality decreased from 3.13% to 2.85% (P = 0.19). After adjustment for baseline differences, mortality was significantly decreased after checklist implementation (odds ratio [OR] 0.85; 95% CI, 0.73-0.98). This effect was strongly related to checklist compliance: the OR for the association between full checklist completion and outcome was 0.44 (95% CI, 0.28-0.70), compared to 1.09 (95% CI, 0.78-1.52) and 1.16 (95% CI, 0.86-1.56) for partial or noncompliance, respectively.
Implementation of the WHO Surgical Checklist reduced in-hospital 30-day mortality. Although the impact on outcome was smaller than previously reported, the effect depended crucially upon checklist compliance.
[Show abstract] [Hide abstract]
ABSTRACT: 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. 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. 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. 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.Patient Safety in Surgery 9(1):5. DOI:10.1186/s13037-014-0056-z
[Show abstract] [Hide abstract]
ABSTRACT: An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked). A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork. One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60). This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork.Anesthesia & Analgesia 03/2015; DOI:10.1213/ANE.0000000000000671 · 3.42 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The last two decades have seen an unprecedented growth in initiatives aimed to improve patient safety. For the most part, however, evidence of their impact remains controversial. At the same time, the healthcare industry has experienced an also unprecedented growth in the amount and variety of available electronic data. In this paper, we provide a review of the use of routinely collected electronic data in the identification, analysis and surveillance of temporal patterns of patient safety. Two important temporal patterns of the safety of hospitalised patients were identified and discussed: long-term trends related to changes in clinical practice and healthcare policy; and shorter term patterns related to variations in workforce and resources. We found that consistency in reporting is intrinsically related to availability of large-scale, fit-for-purpose data. Consistent reported trends of patient harms included an increase in the incidence of post-operative sepsis and a decrease in central-line associated bloodstream infections. Improvement in the treatment of specific diseases, such as cardiac conditions, has also been demonstrated. Linkage of hospital data with other datasets provides essential temporal information about errors, as well as information about unsuspected system deficiencies. It has played an important role in the measurement and analysis of the effects of off-hours hospital operation. Measuring temporal patterns of patient safety is still inadequate with electronic health records not yet playing an important role. Patient safety interventions should not be implemented without a strategy for continuous monitoring of their effect.01/2015; 3(Suppl 1 HISA Big Data in Biomedicine and Healthcare 2013 Con):S2. DOI:10.1186/2047-2501-3-S1-S2