Ian Solsky1, William Berry2, Lizabeth Edmondson1, Janaka Lagoo1, Joshua Baugh3, Alex Blair4, Sara Singer5, Alex B Haynes6. 1. Ariadne Labs, Boston, Massachusetts. 2. Ariadne Labs, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 3. Department of Emergency Medicine, University of California - Los Angeles, Los Angeles, California. 4. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 5. Stanford University School of Medicine and Graduate School of Business, Stanford, California. 6. Ariadne Labs, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Harvard Medical School, Surgery, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: abhaynes@mgh.harvard.edu.
Abstract
BACKGROUND: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. METHODS: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. RESULTS: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's "Anticipated Critical Events" section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. CONCLUSIONS: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's "Anticipated Critical Events" section.
BACKGROUND: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. METHODS: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. RESULTS: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's "Anticipated Critical Events" section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. CONCLUSIONS: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's "Anticipated Critical Events" section.
Authors: Nikhil Panda; Luca Koritsanszky; Megan Delisle; Theophilus T K Anyomih; Eesha V Desai; Yves Sonnay; George Molina; Katayoun Madani; Dominique Vervoort; Thomas G Weiser; Evan M Benjamin; Alex B Haynes Journal: World J Surg Date: 2020-09 Impact factor: 3.352
Authors: Judith Munthali; Chiara Pittalis; Leon Bijlmakers; John Kachimba; Mweene Cheelo; Ruairi Brugha; Jakub Gajewski Journal: BMC Health Serv Res Date: 2022-07-09 Impact factor: 2.908