L. Putnam1,4,5, S. Sakhuja1,4,5, C. M. Chang1,4,5, J. M. Podolnick1,4,5, R. Jain2,5, M. Matuszczak2,5, N. Wadhwa2,5, M. T. Austin1,4,5, L. S. Kao4,6, K. P. Lally1,4,5, K. Tsao1,4,5 5Children’s Memorial Hermann Hospital,Houston, TX, USA 6University Of Texas Health Science Center At Houston,Department Of General Surgery,Houston, TX, USA 1University Of Texas Health Science Center At Houston,Department Of Pediatric Surgery,Houston, TX, USA 2University Of Texas Health Science Center At Houston,Department Of Pediatric Anesthesia,Houston, TX, USA 3University Of Texas Health Science Center At Houston,Medical School,Houston, TX, USA 4Center For Surgical Trials And Evidence-based Practice,Houston, TX, USA
Introduction:
The World Health Organization has promoted utilization of the surgical safety checklist (SSC) as a 3-phase communication tool: pre-induction, pre-incision, and operative debriefing. With the introduction of our pediatric SSC, we demonstrated significant improvement in adherence to the pre-incision phase through a multi-year, multifaceted intervention program directed at stakeholder education, process standardization, and iterative feedback during each phase. Similar efforts were not directed at the pre-induction and operative debriefing components of the SSC. We hypothesized that adherence to the pre-induction and operative debriefing components would be significantly less than to the pre-incision phase of the SSC.
Methods:
From June to August 2014, a direct observational study was conducted during which trained observers within pediatric operating rooms documented completion of checkpoints within all three phases: 11 pre-induction, 14 pre-incision, and 11 debriefing checkpoints. Adherence was defined as verbal confirmation of each checkpoint. Kruskal-Wallis and chi-squared analysis was performed; p-values <0.05 were considered significant.
Results:
224 pre-induction, 247 pre-incision, and 259 debriefing phases of the checklist were observed, including 201 cases in which all three phases were observed. Adherence to the pre-incision phase was consistently high and similar to the previous year (98% and 96%, respectively). However, the pre-induction and operative debriefing phases were significantly worse (Figure). Checkpoint adherence ranged from 9-88% (pre-induction), 93-100% (pre-incision), and 45-88% (debriefing). The lowest checkpoint adherence for both the pre-induction and the debriefing phases was for the announcement of the checklist/debrief (4% and 43%, respectively). The highest checkpoint adherence during the pre-induction phase was noted for verification of surgical and anesthesia consents (88%) whereas confirmation of the procedure and site (86%) had the highest checkpoint adherence during the debriefing.
Conclusions:
Multifaceted interventions have significantly improved adherence to the pre-incision portion of the SSC, yet the pre-induction and debriefing phases of the checklist remain suboptimal. From our previous experience, this lack of adherence may stem from lack of education, process standardization, and performance feedback. Applying similarly targeted interventions towards the pre-induction and debriefing phases of the checklist is required to improve adherence and optimize the benefits of the SSC.
