Jie Tan1, James Reeves Mbori Ngwayi2, Zhaohan Ding3, Yufa Zhou4, Ming Li4, Yujie Chen5, Bingtao Hu6, Jinping Liu7, Daniel Edward Porter8. 1. School of Clinical Medicine, Tsinghua University, Beijing, 100084, China. tanjie@bjmu.edu.cn. 2. School of Clinical Medicine, Tsinghua University, Beijing, 100084, China. 3. Medical Department, Linyi Tumour Hospital, Linyi, 276002, China. 4. Anaesthesiology Department, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China. 5. Department of Trauma and Bone Tumour, Tongji Hospital, Tongji University, Shanghai, 200065, China. 6. Department of Spine Surgery, Luohe Central Hospital, Luohe Medical College, Luohe, 462000, China. 7. Operating Department, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, 100016, China. 8. Department of Orthopaedic Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, 100016, China.
Abstract
BACKGROUND: Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. METHODS: A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. RESULTS: A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the 'time-out' component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. CONCLUSION: The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.
BACKGROUND: Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. METHODS: A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. RESULTS: A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the 'time-out' component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. CONCLUSION: The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.
Authors: Alex B Haynes; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Abdel-Hadi S Breizat; E Patchen Dellinger; Teodoro Herbosa; Sudhir Joseph; Pascience L Kibatala; Marie Carmela M Lapitan; Alan F Merry; Krishna Moorthy; Richard K Reznick; Bryce Taylor; Atul A Gawande Journal: N Engl J Med Date: 2009-01-14 Impact factor: 91.245
Authors: Alex B Haynes; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Abdel-Hadi S Breizat; E Patchen Dellinger; Gerald Dziekan; Teodoro Herbosa; Pascience L Kibatala; Marie Carmela M Lapitan; Alan F Merry; Richard K Reznick; Bryce Taylor; Amit Vats; Atul A Gawande Journal: BMJ Qual Saf Date: 2011-01 Impact factor: 7.035
Authors: Stéphane Cullati; Sophie Le Du; Anne-Claire Raë; Martine Micallef; Ebrahim Khabiri; Aimad Ourahmoune; Armelle Boireaux; Marc Licker; Pierre Chopard Journal: BMJ Qual Saf Date: 2013-03-08 Impact factor: 7.035
Authors: Sabrina J Poon; Scott L Zuckerman; Rajshri Mainthia; Scott L Hagan; D Timothy Lockney; Alexander Zotov; Ginger E Holt; Marc L Bennett; Shilo Anders; Daniel J France Journal: Jt Comm J Qual Patient Saf Date: 2013-02
Authors: S P Pickering; E R Robertson; D Griffin; M Hadi; L J Morgan; K C Catchpole; S New; G Collins; P McCulloch Journal: Br J Surg Date: 2013-11 Impact factor: 6.939
Authors: Jochen Bergs; Frank Lambrechts; Melissa Desmedt; Johan Hellings; Ward Schrooten; Annemie Vlayen; Dominique Vandijck Journal: Int J Qual Health Care Date: 2018-03-01 Impact factor: 2.038
Authors: Steffie M van Schoten; Veerle Kop; Carolien de Blok; Peter Spreeuwenberg; Peter P Groenewegen; Cordula Wagner Journal: BMJ Open Date: 2014-07-03 Impact factor: 2.692