L. R. Putnam1,4,6, C. M. Chang1,4,6, J. M. Podolnick1,4,6, S. Sakhuja1,4,6, R. Jain2,6, M. Matuszczak2,6, M. T. Austin1,4,6, L. S. Kao4,5, K. P. Lally1,4,6, K. Tsao2,4,6 6Children’s Memorial Hermann Hospital,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, TEXAS, USA 5University Of Texas Health Science Center At Houston,Department Of General Surgery,Houston, TX, USA
Introduction:
Consistent and meaningful completion of surgical safety checklists (SSC) has not been widely documented, but it has been shown to require ongoing educational efforts. Adherence to all the checkpoints does not mean they are being completed as they are intended to be (high fidelity). We hypothesized that adherence to the SSC would be significantly higher than actual fidelity within our operating rooms despite our ongoing educational efforts.
Methods:
From June to August 2014, trained observers within pediatric operating rooms documented the completion of 14 pre-incisional checklist checkpoints. The verbal completion of each checkpoint was noted as adherence whereas the correct completion of each checkpoint as defined a priori was noted as fidelity. Fidelity was measured for 7 of the 14 checkpoints as these 7 could be reliably measured and represented enhanced SSC tasks. The fidelity checkpoints included: all personnel quiet and attentive, team member identification, anesthesia induction concerns, prophylactic antibiotics, all equipment available, site marking verification, and essential imaging for surgical sites involving laterality. Chi-square and Student’s t-test were utilized; p-values <0.05 were considered significant.
Results:
247 pre-incisional checklists were observed during the study period. Adherence to all 7 checkpoints was significantly higher than fidelity (97% vs 86%, p<0.01), with checkpoint adherence ranging from 94-100% and checkpoint fidelity from 66-96%. The checkpoint with the highest adherence was team member identification (100%) and with the highest fidelity was anesthesia induction concerns (98%). Imaging for lateral cases had the lowest adherence (94%) and all quiet during the timeout had the lowest fidelity (66%). Adherence was significantly higher than fidelity for each of the 7 checkpoints except for anesthesia induction concerns and essential imaging for lateral cases (Figure).
Conclusion:
Despite nearly 100% adherence to the pre-incisional phase of the SSC within our institution, the fidelity with which it is completed remains suboptimal. Completion of checkpoints does not always reflect purposeful execution. In order to achieve optimal effectiveness, SSC performance should be monitored for adherence to all checkpoints as well as for meaningful intent.
