Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Boston University School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2023 Jun 1;6(6):e2317183. doi: 10.1001/jamanetworkopen.2023.17183.
Modification of the World Health Organization's Surgical Safety Checklist (SSC) is a critical component of its implementation. To facilitate the SSC's use, it is important to know how surgical teams modify their SSCs, their reasons for making modifications, and the opportunities and challenges teams face in SSC tailoring.
To study SSC modifications in high-income hospital settings in 5 countries: Australia, Canada, New Zealand, the United States, and the United Kingdom.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used semistructured interviews based on the survey used in the quantitative study. Each interviewee was asked a core set of questions and various follow-up questions based on their survey responses. Interviews were conducted from July 2019 to February 2020 in person and online using teleconferencing software. Surgeons, anesthesiologists, nurses, and hospital administrators from the 5 countries were recruited through a survey and snowball sampling.
Interviewees' attitudes and perceptions on SSC modifications and their perceived impact on operating rooms.
A total of 51 surgical team members and hospital administrators from the 5 countries were interviewed (37 [75%] with >10 years of service; 28 [55%] women). There were 15 (29%) surgeons, 13 (26%) nurses, 15 (29%) anesthesiologists, and 8 (16%) health administrators. Five themes emerged concerning the awareness and involvement in SSC modifications; reasons for modifications; types of modifications; the outcomes of modifications; and perceived barriers to SSC modifications. Based on the interviews, some SSCs may go many years without being revisited or modified. SSCs are modified to ensure they address local issues and standards of practice and that they are fit for purpose. Modifications are also made following adverse events to reduce the risk of reoccurrence. Interviewees described adding, moving, and removing elements from their SSCs, which increased their sense of ownership in their SSC and participation in its performance. Some barriers to modification included leadership and the SSC's inclusion in hospitals' electronic medical record.
In this qualitative study of surgical team members and administrators, interviewees described addressing contemporary surgical issues through various SSC modifications. The process of SSC modification may improve team cohesion and buy-in in addition to providing opportunities for teams to improve patient safety.
世界卫生组织手术安全检查表（SSC）的修改是其实施的关键组成部分。为了方便 SSC 的使用，了解手术团队如何修改其 SSC、修改的原因以及团队在 SSC 定制方面面临的机会和挑战非常重要。
在澳大利亚、加拿大、新西兰、美国和英国这 5 个高收入国家的医院环境中研究 SSC 的修改。
设计、地点和参与者：这项定性研究使用了基于定量研究中使用的半结构化访谈。根据他们的调查回复，每位受访者都被问到了一组核心问题和各种后续问题。访谈于 2019 年 7 月至 2020 年 2 月在澳大利亚、加拿大、新西兰、美国和英国的 5 个国家进行，采用面对面和在线电话会议软件的方式进行。通过调查和滚雪球抽样，从这 5 个国家招募了外科医生、麻醉师、护士和医院管理人员。
受访者对 SSC 修改的态度和看法，以及他们对手术室的感知影响。
来自这 5 个国家的 51 名外科手术团队成员和医院管理人员接受了采访（服务年限超过 10 年的有 37 人[75%]；女性 28 人[55%]）。受访者中有 15 人（29%）是外科医生，13 人（26%）是护士，15 人（29%）是麻醉师，8 人（16%）是卫生管理人员。出现了 5 个主题，涉及对 SSC 修改的认识和参与；修改的原因；修改的类型；修改的结果；以及对 SSC 修改的感知障碍。根据访谈，一些 SSCs 可能多年来都没有被重新审查或修改。修改 SSCs 是为了确保它们解决当地问题和实践标准，并且适合特定用途。修改还可以在发生不良事件后进行，以降低再次发生的风险。受访者描述了在他们的 SSCs 中添加、移动和删除元素，这增加了他们对 SSC 的所有权和对其执行的参与感。修改的一些障碍包括领导力和 SSC 被纳入医院的电子病历。
在这项对手术团队成员和管理人员的定性研究中，受访者描述了通过各种 SSC 修改来解决当代手术问题。SSC 修改的过程除了为团队提供提高患者安全性的机会外，还可能提高团队凝聚力和参与度。
