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Surgical safety checklist: Productive, non- disruptive, and the "right thing to do"

ARTICLE in JOURNAL OF POSTGRADUATE MEDICINE · MARCH 2015

Impact Factor: 0.86

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7 AUTHORS, INCLUDING:

Ikemefuna Akusoba

St. Luke's University Health Network

7 PUBLICATIONS 2 CITATIONS

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Donna M Sabol

St. Luke's University Health Network

9 PUBLICATIONS 38 CITATIONS

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Stanislaw P. Stawicki

St. Luke's University Health Network

378 PUBLICATIONS 1,915 CITATIONS

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Susan D Moffatt-Bruce

The Ohio State University

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Available from: Stanislaw P. Stawicki

Retrieved on: 09 March 2016

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Y etters ·--·-----

Surgical safety checklist: Productive, nondisruptive, and the 11right thing to do11

Sir, We read with great interest the article bv 0 ,1k el af. 111 on the topic of surgical checklist uti lization in facilitating operative patient safetv. The authors of the manuscript should be congratulated on their contribution to health-care safetv. Regardless of the circumstance, operative indications, or the scope of the procedure, it is important to maintain a uniformly standardized approach to the health-care deliverv process. Critical to the implementation of any system-wide patient safetv measure is the presence of proactive leadership, institutional dialogue, staff training, and built-in avenues for constructive criticism and feedback.121

Perhaps the most important contribution of the surgical safety checklist {SSC) is the increased awareness that patient safety spans the entire spectrum of care delivery and involves e,·ery member of the surgical team. regardless of the level of experience, operative setting, geographic location, or time of the procedtire.1' -'•1 The ability to establish and fos ter the horizontal ''team leadership'' structure, grounded in shared accountabili ty and personal responsibility. is crucial to the successful implementation of the SSC.171 Yet, institutional introductions of the surgical checklist are often faced with the criticism that this added safetv step creates unnecessary delays in an already busy operating room (OR) schedule, that it does not truly benefit the patient, or that its very presence does not ensure enhanced compliance or greater safety.181

The authors of this letter support the notion that the implementation of the SSC must be accompan ied by a permanent change in ''institutional mindset" and a sustained effort to maintain team focus and a culture of safety. l~I Communication between hospital administ rators and practitioners must be open, honest, and constructive in order to obtain the buy-in necessary for the initiative· s success. Regarding the concern thai SSC increa.ses operahve time and introduces unnecessary complexity to an already convoluted process, the authors would like to provide an example from Ohio State Universi ty shO\\~ng that the implementation of the SSC is not dis1uptiYe, and that operative times for one of the most commonly performed procedures - laparoscopic cholecvstectomy - have not been affected following the introduction of the checklist. More specificallv, during the pre-checklist period (2006-2008, average 456 cases per year) the mean time in the OR was 101 min. After the SSC introduction (2009-2012, average 600 cases per year). the mean time in the OR was l 00 min. The percentages of cases longer than 90 min were similar at 46% and 52% during the pre- and post-checklist periods, respectively. Subjective observations from St Luke's University Health etwork also support the productive, nondisruptive nature of the SSC as well as its pivotal role in raising and maintaining organizational awareness of a culture of safety. This is consistently most evident when the surgeon makes the SSC

Journal c,f Postgraduat~ Medicine '!??? 2015 Vol ?? fosue?

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a priority and leads the ·'time out" process. \Vhen evaluating the 4 SSC in the context of "choosing wisely;" it makes perfect sense that 5 the entire operative team should review all critical variables jointly, 6 at one time, and without intenuptions, thus avoiding inefficient, 7 poor!} coordinated, duplicative efforts. s

9 It is the authors' hope that institutions around the globe embrace Jo the SSC as a critical component of the overall multifaceted J l approach to enhance patient safety and reduce operati ve 12 morbidity. mortality, and never events.!1-71 We again congratulate I:; Oak el a/P l on their ouManding contribution to the field of 14 surgical patient safety. J 5

16 Smith EA, Akusoba I, Sabol DM, Stawicki SP, 17

Granson MA, Ellison EC,Moffatt-Bruce SD l ~ Department of Surgery, St Luke's University Health Network, l 9 Bethlehem. Pennsylvania. 1Department of Surgery. The Ohio 20 State University College of Medicine, Columbus, Ohio, USA 2 l

Address for correspondence: Dr. Stanislaw P. Stawicki,

E-mail : stanislaw.stawicki@sluhn.org

References

1. Oak SN , Dave NM. Garasia MB. Parelkar SV. Surgical checklist application and its impact on patient safety in pediatric surgery. J Postgrad Med 2015 ;61 :92-4.

2. Papaconstantinou HT. Jo C, Reznik SI, Smythe WR, Wehbe-Janek H. Implementation of a surgical safety checklist: Impact on surgica l team perspectives. Ochsner J 2013; 13:299-309.

3. Henderson D. Carson-Stevens A, Bohnen J, Gutnik L, Hafiz S, Mills S. Check a box. Save a life: How student leadership is shaking up health care and driving a revolution in patient safety. J Patient Sat 2010;6:43-7.

4. Moftatt-Bruce SD. Ellison EC. Anderson HL 3••, Chan L, Balija TM , Bernescu I. er a/. ; OPUS 12 Foundation . Inc. Multi-Center Tria ls Group. lntravascular retained surgical items : A multicenter study of risk factors. J Surg Res 2012 ; 179:519-23.

5. Stawicki SP. Cook CH . Anderson HL 3••. Chowayou L. Cipol la J. Ahmed HM. et al. ; OPUS 12 Foundation Multicenter Trials Group. Natural history of retained surgical items supports the need for team training, early recognition , and prompt retrieval. Am J Surg 2014;208:65-72.

6. Bergs J. Hellings J . Cleemput I, Zurel b. De Troyer V. Van Hiel M , et al. Systematic review and meta-analysis of the effect of the World Health Organization surgica l safety checklist on postoperative complications. Br J Surg 2014; 101 : 150-8.

7. Stawicki SP. Galwankar SC, Papadimos TJ. Moffatt-Bruce SD. Fundamentals of Patient Safety in Medicine and Surgery. New Delhi , India : Wolters Kluwer Health (India) Pvt Ltd; 2014, pp.66-73.

8. Urbach DR, Govindarajan A. Saskin R. Wilton AS. Baxter NN.

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Introduction of surgical safety checklists in Ontario. Canada. N Engl J Med 2014;370 :1029-38.

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