Abstract
Background
In 2008, the World Health Organisation (WHO) recommended practices to ensure the safety of patients worldwide. This led to the development of the Surgical Safety Checklist (SSC). Ireland has endorsed the SSC (www.hiqa.ie/press-release/2008-06-17-health-information-and-quality-authority-launches-world-health-organization, 10).
Objectives
We aimed to determine (i) whether SSC is being implemented, (ii) whether it promotes a safer surgical environment and (iii) identify problems associated with its introduction and on-going implementation.
Methods
All hospitals in Ireland with operating departments (n = 61) were invited to participate in an online survey.
Results
The response rate was 67 %. The WHO SSC or modified version is in place in 78 % (mean time: 20 months) of operating departments that responded. Partaking in Time Out as a team was reported as occurring in 57 % of cases. Greater than 60 % of respondents reported that the SSC was difficult to introduce and implement and that its introduction was time consuming. Further training in using the SSC was reported as desirable by 84 % of respondents. The introduction of the SSC was reported to be associated with an improvement in team communication (72 %), a positive change in team behaviour (63 %), an increase in the consistency of patient care (82 %) and a positive culture of safety in theatre (81 %).
Conclusion
The SSC has not been implemented throughout all operating departments in Ireland. Where it has been introduced there has been a perceived positive change in safety culture. However, overall greater education, endorsement, teamwork, and communication will be required to optimise the potential benefits associated with this safety instrument. In order to properly determine the benefit of the SSC following its implementation, a formal audit of morbidity and mortality is required.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144
Gawande AA, Thomas EJ, Zinner MJ et al (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75. doi:10.1067/msy.1999.98664
Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276. doi:10.1093/intqhc/14.4.269
Haynes AB, Weiser TG, Berry WR et al (2009) Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499. doi:10.1056/NEJMsa0810119
Lingard L, Regehr G, Orser B et al (2008) Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg 143:12–18. doi:10.1056/NEJMsa0810119
Makary MA, Sexton JB, Freischlag JA et al (2006) Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 202:746–752. doi:10.1016/j.jamcollsurg.2006.01.017
Mazzocco K, Petitti DB, Fong KT et al (2009) Surgical team behaviors and patient outcomes. Am J Surg 197(5):678–685. doi:10.1016/j.amjsurg.2008.03.002
Sexton JB, Makary MA, Tersigni AR et al (2006) Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel. Anesthesiology 105:877–884
World Health Organization (2008) Patient safety: surgical safety web map. Available at: http://maps.cga.harvard.edu:8080/Hospital/. Accessed 25 May 2012
www.hiqa.ie/press-release/2008-06-17-health-information-and-quality-authority-launches-world-health-organization. Accessed 25 May 2012
World Health Organisation (2008) Implementation manual surgical safety checklist, 1st edn. Available at: http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Manual_finalJun08.pdf. Accessed 30 Jun 2012
Mahajan RP (2011) The WHO surgical checklist. Best Pract Res Clin Anaesthesiol 25(2):161–168
Haynes AB, Weiser TG, Berry WR et al (2011) Safe Surgery Saves Lives Study Group. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Saf 20(1):102–107. doi:10.1136/bmjqs.2009.040022
Weiser TG, Haynes AB, Dziekan G et al (2010) Safe Surgery Saves Lives Investigators and Study Group. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 251(5):976–980. doi:10.1097/SLA.0b013e3181d970e3
Horton R (2008) Editorial. WHO’s patient-safety checklist for surgery. Lancet 372(9632):1. doi:10.1016/S0140-6736(08)60878-8
Greenhalgh T, Robert G, Macfarlane F et al (2004) Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 82:581–629. doi:10.1002/9780470987407.fmatter
Damschroder LJ, Aron DC, Keith RE et al (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 4:50. doi:10.1186/1748-5908-4-50
Bosk CL, Dixon-Woods M, Goeschel CA et al (2009) The art of medicine: reality check for checklists. Lancet 374:444–445. doi:10.1016/S0140-6736(09)61440-9
Huang DT, Clermont G, Sexton JB et al (2007) Perceptions of safety culture vary across the intensive care units of a single institution. Crit Care Med 35(1):165–176
Carney BT, West P, Neily J et al (2010) Differences in nurse and surgeon perceptions of teamwork: implications for use of a briefing checklist in the OR. AORN J 91(6):722–729. doi:10.1016/j.aorn.2009.11.066
Cuschieri A (2005) Reducing errors in the operating room: surgical proficiency and quality assurance of execution. Surg Endosc 19(8):1022–1027. doi:10.1007/s00464-005-8110-7
Greenberg CC, Regenbogen SE, Studdert DM et al (2007) Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg 204:533–540. doi:10.1016/j.jamcollsurg.2007.01.010
Griffen FD, Stephens LS, Alexander JB et al (2007) The American College of Surgeons’ closed claims study: new insights for improving care. J Am Coll Surg 204:561–569. doi:10.1016/j.jamcollsurg.2007.01.013
de Vries EN, Prins HA, Crolla RM et al (2010) SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 363(20):1928–1937. doi:10.1056/NEJMsa0911535
Acknowledgments
All the surgical theatre staff who participated in the survey.
Conflict of interest
No competing interests to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nugent, E., Hseino, H., Ryan, K. et al. The surgical safety checklist survey: a national perspective on patient safety. Ir J Med Sci 182, 171–176 (2013). https://doi.org/10.1007/s11845-012-0851-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-012-0851-4