University of Toronto, ON, Canada.
University of Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada.
Surgery. 2019 Apr;165(4):832-837. doi: 10.1016/j.surg.2018.09.012. Epub 2018 Nov 24.
The surgical safety checklist is an evidence-based global initiative designed to reduce perioperative morbidity and mortality. However, the expounded benefits of the surgical safety checklist have not been realized in naturalistic settings. This may be related to the quality of surgical safety checklists being performed in operating rooms.
In this explanatory, sequential, mixed-methods study, 2 trained observers used a standardized tool to record the compliance and quality of the surgical safety checklist completed during 51 surgeries performed at a pediatric academic hospital. We compared compliance with each phase of the surgical safety checklist, the number of checklist items completed, and professionals initiating the surgical safety checklist across surgical specialties and case urgency levels. Interviews with nurses, anesthesiologists, and surgeons (n = 18) were subsequently conducted to explore and contextualize the findings.
Hospital-recorded surgical safety checklist compliance (94%, 100%, and 100% on briefing, time out, and debriefing) was higher than the proportion of checklist items completed in matched cases (26%, 59%, and 42%, respectively). Thematic analysis of the interview data suggests this may result from limited staff "buy in," arising from the "top-down" mandated nature of the surgical safety checklist, the perceived lack of benefit in surgical safety checklist completion, and redundancies with other operating room processes. This has led to the surgical safety checklist becoming "an exercise in box ticking" (ie, compliance is recorded without ensuring quality), thereby obfuscating potential safety benefits.
These results highlight that compliance data are insufficient for monitoring surgical safety checklist quality. Our study suggests that surgical safety checklist quality may be enhanced through better calibration of the surgical safety checklist with existing procedures and staff expectations through a bottom-up implementation strategy.
手术安全检查表是一项基于证据的全球倡议，旨在降低围手术期发病率和死亡率。然而，在自然环境中，手术安全检查表的益处并未得到体现。这可能与手术室中执行手术安全检查表的质量有关。
在这项解释性、顺序性、混合方法研究中，2 名经过培训的观察员使用标准化工具记录了在一家儿科医院进行的 51 例手术中完成的手术安全检查表的依从性和质量。我们比较了各手术安全检查表阶段的依从性、完成的检查表项目数量以及各手术专业和手术紧急程度下启动手术安全检查表的专业人员。随后对护士、麻醉师和外科医生（n=18）进行了访谈，以探讨和说明这些发现。
医院记录的手术安全检查表依从率（介绍、时间暂停和总结阶段分别为 94%、100%和 100%）高于匹配病例中完成的检查表项目比例（分别为 26%、59%和 42%）。访谈数据的主题分析表明，这可能是由于工作人员“参与度有限”造成的，这是由于手术安全检查表具有“自上而下”的强制性性质，完成手术安全检查表的益处被认为不足，并且与其他手术室流程存在重叠。这导致手术安全检查表成为“一种形式主义的练习”（即，记录了依从性，但没有确保质量），从而掩盖了潜在的安全益处。
这些结果表明，仅监测手术安全检查表的依从性数据不足以评估其质量。我们的研究表明，通过从下至上的实施策略，更好地校准手术安全检查表与现有程序和员工期望，可以提高手术安全检查表的质量。
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