The influence of Occupation and Teamwork on the Successful Use of the WHO Surgical Checklist: Experiences of Swedish Healthcare Professionals

Background: Every year, some 300 million operations are performed around the world, with approximately 700,000 in Sweden. This represents about one surgical procedure per 25 people. All these operations are not free of risk. The safety of patients can be enhanced by teamwork, good communication and checklists ensuring adherence to safety routines. The aim of the present study was to describe the experience of Swedish healthcare professionals of using the WHO surgical checklist, with special emphasis on different occupations and teamwork. Methods:A descriptive cross-sectional statistical study, including healthcare professionals from two departments at a university hospital in the western part of Sweden, was conducted. Data were collected from one hundred and ninety-six healthcare professionals, using a self-administered questionnaire that contained 12 questions. The Mantel-Haenszel and Pearson χ2 tests were used for ordered and unordered categorical variables. Results: One hundred and ninety-six healthcare professionals, aged 21-73, and 6 different categories with 5-25 years experiences participated. Regarding the usage of the checklist at different departments, the biggest different was about responsibility to implementation of the checklist (p=0,001), using the checklist in the emergency situations (p=0.04), if the checklist improve patient’s safety (p=0.04), and if the list has been completed correctly (p=0,006). Regarding the training for using the checklist, anaesthetist nurses were most negative with 75,5%, and the operating nurses were most positive with 39.2 %. 66,0 % of nurse anaesthetists, the checklist was adapted to the department. Majority of all the occupations thought that the checklist improved patients safety, and that the checklist had been correctly completed. Conclusion: Different departments and different occupations experience difficulties using the checklist in the Swedish healthcare system. More research is needed to investigate the experiences of healthcare professionals, whether different occupations report differently about using the checklist and whether teamwork is influenced by using the checklist. A further understanding of the checklist and its importance, as well as its content, could increase the safety of patients due to improved compliance. Key words: WHO checklist, surgery, occupation, teamwork questionnaire, research .

SP2.2.10Barriers to Compliance of the WHO Safe Surgical Checklist in an Ethiopian Tertiary Referral Centre

Aims Ethiopia is the world’s 12th most populous country, with a health care system currently undergoing significant development. Current data shows perioperative mortality at 7%, compared to the 0.4– 0.8% reported in more economically developed countries. In 2008 the WHO created the Safe Surgical Checklist (SSC), globally shown to dramatically improve perioperative mortality and used throughout Ethiopia since 2010. The author aimed to review compliance to this checklist within emergency theatres in Ethiopia and assess potential barriers to its use. Methods A prospective observational study was undertaken at Felege Hiwot Referral Hospital, a tertiary referral hospital in Northwest Ethiopia, over a six-week period. 70 emergency operations were directly observed. Results The SSC was used in 0 out of 70 cases, no surgical pauses were observed and during each operation, a member of the anaesthetic team was observed to tick each box incorrectly as completed while finalising paperwork at the end of the case. Interviews with surgical and anaesthetic staff members revealed poor compliance to be secondary to a lack of knowledge of the benefits of the checklist and no training in its use. Conclusions After its introduction in 2008 compliance with SSC was poor globally, with the published data revealing this to be secondary to poor initial implementation from senior hospital staff and a lack of staff training. While compliance has improved in more economically developed countries, the same barriers are still faced in Ethiopia. These barriers must be targeted in order to improve perioperative outcomes.

Developing the ‘checking’ discipline

We explore how engagement with checklists and adoption of a strict ‘checking’ discipline help avoid unintentional individual, team and systemic errors. Paradoxically, this is equally important when performing repetitive mundane tasks as well as during times of high-stress workload. In this article, we aim to discuss the different types of checklists and explain how deviations from a ‘checking’ discipline can lead to never events such as wrong side or site surgery. Well-designed checklists function as mental notes and prompts in clinical situations where the combination of fatigue and stress can contribute to a decline in cognitive performance. Furthermore, the need for proactive discussion by all members of the team during the implementation of the surgical checklist also reinforces the concept of teamwork and contributes towards effective communication. Patient safety is often a product of good communication, teamwork and anticipation: a ‘checking’ mentality remains the lynchpin which links these factors.

Impact of surgical checklist and its completion on complications and mortality in urgent colorectal procedures

ABSTRACT Objective: to assess the impact of using a surgical checklist and its completion on complications such as surgical site infection (SSI), reoperation, readmission, and mortality in patients subjected to urgent colorectal procedures, as well as the reasons for non adherence to this instrument in this scenario, in a university hospital in Ottawa, Canada. Methods: this is a retrospective, epidemiological study. We collected data from an electronic database containing information on patients undergoing urgent colorectal operations, and analyzed the occurrence of SSI, reoperation, readmission, and death in a 30 day period, as well as the completion of the checklist. We conducted a descriptive statistical analysis and logistic regression. Results: we included 5,145 records, of which 5,083 (98.8%) had complete checklists. As for the outcomes evaluated, cases with complete checklists displayed higher SSI rate, 9.1% vs. 6.5% (p=0.466), lower reoperation rate, 5% vs.11.3% (p=0.023), lower readmission rates, 7.2% vs. 11.3% (p=0.209), and lower mortality, 3.0% vs. 6.5% (p=0.108) than cases with incomplete ones. Conclusion: there was a high level of checklist completion and a larger number of the outcomes in the reduced percentage of incomplete checklists found, demonstrating the impact of its utilization on the safety of patients undergoing urgent operations.