Luke R Putnam1, Shauna M Levy1, Madiha Sajid2, Danielle A Dubuisson2, Nathan B Rogers2, Lillian S Kao3, Kevin P Lally1, KuoJen Tsao4. 1. Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. 2. Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX. 3. Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. 4. Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. Electronic address: kuojen.tsao@uth.tmc.edu.
Abstract
INTRODUCTION: Adherence to surgical safety checklists remains challenging. Our institution demonstrated acceptable rates of checklist utilization but poor adherence to all checkpoints. We hypothesized that stepwise, multifaceted interventions would improve checklist adherence. METHODS: From 2011 to 2013, adherence to the 14-point, pre-incision checklist was assessed directly by trained observers during three, 1-year periods (baseline, observation #1, and observation #2) during which interventions were implemented. Interventions included safety workshops, customization of a stakeholder-derived checklist, and implementation of a report card system. Chi-square and Kruskal-Wallis tests were utilized. RESULTS: Checklist performance was assessed for 873 cases (baseline, n = 144; observation #1, n = 373; observation #2, n = 356). Total checkpoint adherence increased (from 30% to 78% to 96%; P < .001), as did cases with correct completion of all checkpoints (from 0% to 19% to 61%; P < .001). The median (interquartile range) number of checkpoints completed per case improved from 4 (3-5) to 11 (10-12) to 14 (13-14; P < .001). CONCLUSION: A strategic, multifaceted approach to perioperative safety significantly improved checklist adherence over 2 years. Checklist content and process need to reflect local interests and operative flow to achieve high adherence rates. Successful checklist implementation requires efforts to change the safety culture, stakeholder buy-in, and sustained efforts over time.
INTRODUCTION: Adherence to surgical safety checklists remains challenging. Our institution demonstrated acceptable rates of checklist utilization but poor adherence to all checkpoints. We hypothesized that stepwise, multifaceted interventions would improve checklist adherence. METHODS: From 2011 to 2013, adherence to the 14-point, pre-incision checklist was assessed directly by trained observers during three, 1-year periods (baseline, observation #1, and observation #2) during which interventions were implemented. Interventions included safety workshops, customization of a stakeholder-derived checklist, and implementation of a report card system. Chi-square and Kruskal-Wallis tests were utilized. RESULTS: Checklist performance was assessed for 873 cases (baseline, n = 144; observation #1, n = 373; observation #2, n = 356). Total checkpoint adherence increased (from 30% to 78% to 96%; P < .001), as did cases with correct completion of all checkpoints (from 0% to 19% to 61%; P < .001). The median (interquartile range) number of checkpoints completed per case improved from 4 (3-5) to 11 (10-12) to 14 (13-14; P < .001). CONCLUSION: A strategic, multifaceted approach to perioperative safety significantly improved checklist adherence over 2 years. Checklist content and process need to reflect local interests and operative flow to achieve high adherence rates. Successful checklist implementation requires efforts to change the safety culture, stakeholder buy-in, and sustained efforts over time.
Authors: Janaka Lagoo; Steven R Lopushinsky; Alex B Haynes; Paul Bain; Helene Flageole; Erik D Skarsgard; Mary E Brindle Journal: BMJ Open Date: 2017-10-16 Impact factor: 2.692
Authors: Arwa M Hosny El-Shafei; Sahar Yassin Ibrahim; Ayat Mahmoud Tawfik; Shaimaa A M Abd El Fatah Journal: Open Access Maced J Med Sci Date: 2019-10-14