Dataset Information

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation.

ABSTRACT:

Background

The World Health Organization's Global Patient Safety Action Plan 2021-2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients' involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients' completion. Studies on such checklists are small scale, but they are linked to reduction in length of hospital stay and readmissions. We have previously developed and validated a two-part surgical patient safety checklist (PASC). This study aims to investigate the feasibility of the PASC usage and implementation prior to its use in a large-scale clinical trial.

Methods

This is a prospective cross-sectional feasibility study, set up as part of the design of a larger stepped-wedge cluster randomised controlled trial (SW-CRCT). Descriptive statistics were used to investigate patient demographics, reasons for not completing the PASC and percentage of PASC item usage. Qualitative patient interviews were used to identify barriers and drivers for implementation. Interview was analysed through content analysis.

Results

Out of 428 recruited patients, 50.2% (215/428) used both parts of PASC. A total of 24.1% (103/428) of the patients did not use it at all due to surgical or COVID-19-related cancellations. A total of 19.9% (85/428) did not consent to participate, 5.1% (22/428) lost the checklist and 0.7% (3/428) of the patients died during the study. A total of 86.5% (186/215) patients used ≥ 80% of the checklist items. Barriers and drivers for PASC implementation were grouped into the following categories: Time frame for completing the checklist, patient safety checklist design, impetus to communicate with healthcare professionals and support throughout the surgical pathway.

Conclusions

Elective surgical patients were willing and able to use PASC. The study further revealed a set of barriers and drivers to the implementation. A large-scale definitive clinical-implementation hybrid trial is being launched to ascertain the clinical effectiveness and scalability of PASC in improving surgical patient safety.

Trial registration

Clinicaltrials.gov: NCT03105713. Registered 10.04.2017.

SUBMITTER: Harris K

PROVIDER: S-EPMC10040905 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation.

Harris Kristin K Søfteland Eirik E Moi Asgjerd Litleré AL Harthug Stig S Ravnøy Mette M Storesund Anette A Jurmy Elaheh E Skeie Eli E Wæhle Hilde Valen HV Sevdalis Nick N Haugen Arvid Steinar AS

Pilot and feasibility studies 20230327 1

<h4>Background</h4>The World Health Organization's Global Patient Safety Action Plan 2021-2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients' involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients' completion. Studies on such checklists are small scale, but they are linked t ...[more]

PMID: 36973815

Similar Datasets

Project description:BackgroundThe Surgical Safety Checklist (SSC) is a cornerstone of ensuring the safety and accuracy of communication among interdisciplinary teams in the operating room. Central to the successful implementation of such a checklist is the concept of psychological safety. Despite the extensive body of research on the checklists' efficacy, the association between healthcare professionals' (HCPs) perceptions of the checklist and their level of psychological safety remains uninvestigated. This study attempts to address this gap by examining how their perceptions of the checklist intersect with their sense of psychological safety.MethodsA cross-sectional survey comprising 25 items was conducted from November 2022 to January 2023 on; Demographics (6 items), the SSC (12 items), and the Psychological Safety Scale (7 items). We invited 125 HCPs from five different professional groups in the operation ward to complete the survey.ResultsOf the 125 asked to participate, 107 responded, and 100 of whom completed the entire survey. The level of psychological safety increased by 1.25 (95 % CI 0.36 to 2.14, p=0.006) per one-point increase of the perception that colleagues listen when checklist items are being reviewed, and increased by 1.1 (95% CI 0.4 to 1.7, p=0.002) per one-point increase in the perception that the checklist enhances interdisciplinary teamwork, and increased by 0.86 (95% CI 0.15 to 1.57, p=0.02) per one-point increase in the perception that the checklist provides structure in the operating room. Conversely, the level of psychological safety decreased by 1.4 (95 % CI 0.5 to 2.3, p=0.004) per one-point increase in the perception that the checklist is time-consuming.ConclusionOur findings reveal a significant association between psychological safety levels and perceptions of the SSC. Increased psychological safety was linked to more positive views on the checklist's role in enhancing interdisciplinary teamwork, creating structure and attentiveness among colleagues. While seeing the checklist as time-consuming was associated with a lower psychological safety rating. These results suggest that psychological safety influences how individuals view and engage with patient safety measures like the checklist, highlighting the importance of fostering a supportive environment to optimise safety practice.

Project description:BackgroundIt is well known that the implementation of the WHO surgical safety checklist (SSC) leads to improved operating room team coordination and reduced perioperative complication and mortality rates. Although it is proven to be beneficial worldwide, its awareness and usage need to be evaluated in a diverse country like India. As orthopaedic surgeries involve implants and tourniquet usage, it is important to evaluate the applicability of WHO SSC specifically to orthopaedic surgeries, and whether any modifications are needed.Materials and methodsA web-based cross-sectional survey was conducted among Indian Orthopaedic Surgeons with a pre-defined questionnaire regarding awareness, usage and suggestions to modify the existing WHO SSC (2009) for orthopaedic surgeries.Results513 responses were included for final analysis. 90.3% of surgeons were aware of the surgical safety checklist; however, only 55.8% used it routinely in their practice. The awareness of SSC availability was 1.85 times more among younger surgeons (< 20 years of experience) than among those with > 20 years of experience. 17% of surgeons thought the usage of SSC was time-consuming and 52.4% of participants felt a need to modify the existing WHO SSC (2009) for orthopaedic surgeries. 34.5% recommended the inclusion of the patient blood group in the "Sign-in" section, 62.77% proposed the inclusion of details about the tourniquet, whereas only 6.63% suggested adding about surgical implant readiness in the "Time-out" section and 72.7% suggested including a check to make sure the tourniquet was deflated, removed and also recording of the total usage time during the "Sign-out" section.ConclusionDespite high (90%) awareness among Indian Orthopaedic surgeons, they have limited usage of the WHO SSC in their practice. Identifying barriers and considering modifications for orthopaedic surgeries, like details about tourniquet usage during the "Time-out" section and a check to ensure it was removed during the "Sign-out" section, will improve patient safety and outcomes.Graphical abstractSupplementary informationThe online version contains supplementary material available at 10.1007/s43465-024-01096-5.

Project description:BackgroundPatients' involvement in patient safety has increased in healthcare. Use of checklists may improve patient outcome in surgery, though few have attempted to engage patients' use of surgical checklist. To identify risk elements of complications based on patients' and healthcare workers' experiences is warranted. This study aims to identify what the patients and healthcare workers find to be the risk elements that should be included in a patient-driven surgical patient safety checklist.MethodA qualitative study design where post-operative patients, surgeons, ward physicians, ward nurses, and secretaries from five surgical specialties took part in focus group interviews. Eleven focus groups were conducted including 25 post-operative patients and 27 healthcare workers at one tertiary teaching hospital and one community hospital in Norway. Based on their experiences, participants were asked to identify perceived risks before and after surgery. The interviews were analysed using content analysis.ResultsSafety risk factors were categorised as pre-operative information: pre-operative preparations, post-operative information, post-operative plans and follow-up. The subcategories under pre-operative information and preparations were: contact information, medication safety, health status, optimising health, dental status, read information, preparation two weeks before surgery, inform your surgical ward, planning your own discharge, preparation on admission and just before surgery. The subcategories under post-operative information, further plans and follow-up were: prevention and complications, restriction and activity, medication safety, pain relief, stomach functions, further care and appointments. Both healthcare workers and patients express the need for a surgical patient safety checklist.ConclusionA broad spectre of risk elements for a patient safety checklist were identified. Developing a surgical safety checklist based on these risk elements might reduce complications and unwanted errors.Trail registrationThe study is registered as part of a clinical trial in ClinicalTrials.gov: NCT03105713.

Project description:BackgroundPoor uptake and understanding of critical perioperative information represent a major safety risk for surgical patients. Implementing a patient-driven surgical safety checklist might enhance the way critical information is given and increase patient involvement in their own safety throughout the surgical pathway. The aim of this study was to develop and validate a Surgical Patient Safety Checklist (PASC) for use by surgical patients.MethodThis was a prospective study, involving patient representatives, multidisciplinary healthcare professionals and elective surgical patients to develop and validate PASC using consensus-building techniques in two Norwegian hospitals. A set of items intended for PASC were rated by patients and then submitted to Content Validation Index (CVI) analyses. Items of low CVI went through a Healthcare Failure Mode and Effect Analysis (HFMEA) Hazard Scoring process, as well as a consensus process before they were either kept or discarded. Reliability of patients' PASC ratings was assessed using Intraclass Correlation Coefficient analysis. Lastly, the face validity of PASC was investigated through focus group interviews with postoperative patients.ResultsInitial development of PASC resulted in a checklist consisting of two parts, one before (32 items) and one after surgery (26 items). After achieving consensus on the PASC content, 215 surgical patients from six surgical wards rated the items for the CVI analysis on a 1-4 scale and mostly agreed on the content. Five items were removed from the checklist, and six items were redesigned to improve PASCs' user-friendliness. The total Scale-level index/Average (S-CVI/Ave) before revision was 0.83 and 0.86 for pre- and post-operative PASC items, respectively. Following revision, these increased to 0.86 and 0.93, respectively. The PASC items reliability score was 0.97 (95% confidence interval 0.96 to 0.98). The qualitative assessment identified that patients who used PASC felt more in control of their situation; this was achieved when PASC was given to them at what they felt was the right time and healthcare professionals took part in its usage.ConclusionMultidisciplinary perioperative care staff and surgical patients agreed upon PASC content, the checklist ratings were reliable, and qualitative assessment suggested good face validity. PASC appears to be a usable and valid checklist for elective surgical patients across specialties.

Project description:BackgroundThe 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypothesized that, using a three-day course, successful wide-scale implementation of the checklist could be achieved, as measured by at least 50% compliance with six basic safety processes at three to four months. We also aimed to determine predictors for checklist utilization.Materials and methodsUsing a blended educational implementation strategy based on prior pilot studies we designed a three-day dynamic educational course to facilitate widespread implementation of the WHO checklist. The course utilized lectures, film, small group breakouts, participant feedback and simulation to teach the knowledge, skills and behavior changes needed to implement the checklist. In collaboration with the Ministry of Health and local hospital leadership, the course was delivered to 427 multi-disciplinary staff at 21 hospitals located in 19 of 22 regions of Madagascar between September 2015 and March 2016. We evaluated implementation at three to four months using questionnaires (with a 5-point Likert scale) and focus groups. Multivariate linear regression was used to test predictors of checklist utilization.ResultsAt three to four months, 65% of respondents reported always using the checklist, with another 13% using it in part. Participant's years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with counting instruments (p< 0.05), but not with verifying: patient identity, difficult intubation risk, risk of blood loss, prophylactic antibiotic administration, or counting needles and sponges.ConclusionUse of a multi-disciplinary three-day course for checklist implementation resulted in 78% of participants using the checklist, at three months; and an increase in counting surgical instruments. Successful checklist implementation was not predicted by participant length of medical service, hospital size or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.

Dataset Information

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation.

Background

Methods

Results

Conclusions

Trial registration

Publications

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation.

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