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Effect of the surgical safety checklist on provider and patient outcomes: a systematic review
  1. Bonnie A. Armstrong1,
  2. Ilinca A. Dutescu1,
  3. Lori Nemoy1,
  4. Ekta Bhavsar1,
  5. Diana N. Carter2,
  6. Kimberley-Dale Ng3,
  7. Sylvain Boet4,5,6,7,8,9,
  8. Patricia Trbovich3,10,11,
  9. Vanessa Palter1
  1. 1 Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
  2. 2 General Surgery, Milton District Hospital, Milton, Ontario, Canada
  3. 3 Surgery, North York General Hospital, Toronto, ON, Canada
  4. 4 Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
  5. 5 Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
  6. 6 Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
  7. 7 Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
  8. 8 Institut du Savoir Montfort, Ottawa, ON, Canada
  9. 9 Faculty of Education, University of Ottawa, Ottawa, ON, Canada
  10. 10 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
  11. 11 Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
  1. Correspondence to Dr Bonnie A. Armstrong, Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada, M5B 1T8; bonnie.armstrong{at}utoronto.ca

Abstract

Background Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships.

Methods A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects.

Results 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC’s influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators.

Conclusion There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.

  • attitudes
  • checklists
  • communication
  • safety culture
  • compliance

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Twitter @Sylvainboet

  • Contributors BAA (guarantor): idea generation, study screening, data extraction, analysis, risk of bias assessments, manuscript writing and revisions. IAD: study screening, data extraction, analysis, risk of bias assessments, manuscript writing and revisions. LN: idea generation, study screening, data extraction, analysis, manuscript writing and revisions. EB: study screening, data extraction and manuscript revisions. DNC: study screening, data extraction, manuscript writing and revisions. K-DN: study screening and data extraction. SB, PT: manuscript writing and revisions. VP: idea generation, manuscript writing and revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Dr. Boet's research is supported by The Ottawa Hospital Anesthesia Alternate Funds Association and the Faculty of Medicine, University of Ottawa with a Tier 2 Clinical Research Chair.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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