Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery, University of Texas Medical School at Houston, 77030, USA.
Surgery. 2012 Sep;152(3):331-6. doi: 10.1016/j.surg.2012.05.034. Epub 2012 Jul 6.
Perioperative checklists are mandated by many hospitals as determined by the reduction in morbidity and mortality seen with the use of the World Health Organization's Surgical Safety Checklist. An adapted perioperative checklist was implemented within our hospital system, and compliance with the checklist was reported to be 100%. We hypothesized that compliance does not measure the fidelity of implementation.
During a 7-week period, a prospective study was performed to evaluate the completion of all preincision components of the surgical checklist. Pediatric surgical operations were selected for direct observation. In addition, a poststudy survey was used to assess perception and understanding of the checklist process.
A total of 142 pediatric surgical cases were observed. Hospital reported data demonstrated 100% compliance with the preincision phase of the checklist for these cases. None of the cases completely executed all items on the checklist, and the average number of checklist items performed in the observed cases was 4 of 13. The most commonly performed checkpoint were the confirmation of patient name and procedure (99%) and the "timeout" at the start of the checklist (97%). The rest of the checkpoints were performed in less than 60% of cases. Adherence did not increase during the observation period.
These data show that despite the 100% documented completion of the preincision phase of the checklist; most of the individual checkpoints are either not executed as designed or not executed at all. These findings demonstrate lack of checklist implementation fidelity, which may be a reflection a poor implementation and dissemination strategy.
许多医院都规定了围手术期检查表，这是世卫组织手术安全检查表的使用降低发病率和死亡率的结果。我们的医院系统实施了一份经过改编的围手术期检查表，其执行率报告为 100%。我们假设合规并不能衡量实施的保真度。
在为期 7 周的时间内，进行了一项前瞻性研究，以评估手术检查表所有术前部分的完成情况。选择小儿外科手术进行直接观察。此外，还使用了一项研究后调查来评估对检查表流程的认知和理解。
共观察了 142 例小儿外科手术。医院报告的数据显示，这些病例的术前检查表执行率为 100%。没有一个病例完全执行了检查表上的所有项目，在观察到的病例中，检查表项目的平均执行数为 13 项中的 4 项。执行最多的检查点是确认患者姓名和手术程序（99%）和检查表开始时的“暂停”（97%）。其余检查点的执行率不到 60%。在观察期间，遵守率并没有增加。
这些数据表明，尽管检查表的术前阶段在文件上记录的完成率为 100%；但大多数单独的检查点要么没有按设计执行，要么根本没有执行。这些发现表明检查表的实施保真度不足，这可能反映了实施和传播策略不佳。
