From the Health Data Department, Hospices Civils de Lyon.
Brigham and Women's Hospital, Harvard Medical School.
J Patient Saf. 2022 Aug 1;18(5):449-456. doi: 10.1097/PTS.0000000000000954. Epub 2021 Dec 17.
How the checklist is executed in routine practice may reflect the teamwork and safety climate in the operating room (OR). This cross-sectional study aimed to identify whether the presence of a fully completed checklist in medical records was associated with teams' safety attitudes.
Data from 29 French hospitals, including 5677 operated patients and 834 OR professionals, were prospectively collected. The degree of checklist compliance was categorized for each patient in 1 of 4 ways: full, incomplete, inaccurate, and no checklist completed. The members of OR teams were invited to complete a questionnaire including teamwork climate measurement (Safety Attitudes Questionnaire) and their opinion regarding checklist use, checklist audibly reading, and communication change with checklist. Multilevel modeling was performed to investigate the effect of variables related to hospitals and professionals on checklist compliance, after adjustment for patient characteristics.
A checklist was present for 83% of patients, but only 35% demonstrated full completion. Compared with no checklist, full completion was associated with higher safety attitude (high teamwork climate [adjusted odds ratio for full completion, 4.14; 95% confidence interval, 1.75-9.76]; communication change [1.31, 1.04-1.66]; checklist aloud reading [1.16, 1.02-1.32]) and was reinforced by the designation of a checklist coordinator (2.43, 1.06-5.55). Incomplete completion was also associated with enhanced safety attitude contrary to inaccurate completion.
Compliance with checklists is associated with safer OR team practice and can be considered as an indicator of the extent of safety in OR practice.
清单在常规实践中的执行情况可能反映了手术室（OR）中的团队合作和安全氛围。本横断面研究旨在确定病历中是否存在完整填写的清单是否与团队的安全态度有关。
前瞻性收集了来自 29 家法国医院的数据，包括 5677 名手术患者和 834 名手术室专业人员。对每位患者的清单遵守程度进行了 4 种分类之一：完整、不完整、不准确和未完成清单。邀请手术室团队成员填写一份问卷，其中包括团队合作氛围测量（安全态度问卷）以及他们对清单使用、清单大声朗读和清单沟通变化的看法。进行多水平建模，以调查与医院和专业人员相关的变量对清单遵守情况的影响，调整患者特征后进行。
83%的患者有清单，但只有 35%的患者完成了完整填写。与无清单相比，完整填写与更高的安全态度相关（高团队合作氛围[完整填写的调整优势比，4.14；95%置信区间，1.75-9.76]；沟通变化[1.31，1.04-1.66]；清单大声朗读[1.16，1.02-1.32]），并由清单协调员指定得到加强（2.43，1.06-5.55）。不完整的完成也与增强的安全态度相关，而不准确的完成则相反。
清单的遵守与更安全的手术室团队实践相关，可被视为手术室实践中安全程度的指标。
