Improving surgical safety checklist completion using distributed responsibility of checklist item completion among operating room team members: A quality improvement project

Background. Surgical safety checklists are a standard of care for safe operating room practice, but their use has not been associated with reductions in adverse perioperative outcomes in some settings. Non-adherence and partial checklist completion may contribute to this lack of effect. Objective. To examine whether a surgical safety checklist using distributed responsibility of checklist item completion, by allocation of questions and responses among operating room staff, increases surgical safety checklist compliance. Methods. With Quality and Risk Management approval, a multicomponent strategy consisting of novel surgical safety checklist focused on distributed responsibility of checklist item completion was evaluated in orthopaedic operating rooms at The Hospital for Sick Children, Toronto, from July to August 2016 using a before-and-after study design. The intervention consisted of a wall-mounted reusable checklist with questions and responses designated to specific operating room team members. Team training was provided beforehand, operating room team leaders were identified to promote the intervention, and revisions to the checklist content and process were implemented based on feedback on feasibility and clinical sensibility. Results. A total of 45 and 59 children were included in pre-intervention and intervention groups, respectively. Overall, 87% (1,354/1,560) of checklist items were observed. Checklist item completion was significantly increased in the post-intervention group (77% [615/802]) compared with the pre-intervention group (27% [150/522]) (P<0.001). Conclusions. These findings suggest that a multicomponent strategy of designating responsibility for item completion among operating room team members and using a memory aid can improve compliance with surgical safety checklist item completion.