A Multi-Faceted Progress Evaluation of the Use of the Surgical Safety Checklist

Quality Forum 2012March 8th, 2012

Allison Muniak (nee Lamsdale), M.A.ScHuman Factors SpecialistQuality & Patient Safety

Authors

• Allison Muniak• Claire O’Quinn • Dermot Kelly • Meghan MacLeod • Kelle Payne• Linda Dempster

Work completed by Vancouver Coastal Health and

Providence Healthcare

BackgroundSafety Checklists:

Communication tools to empower teams by increasing situational awareness, teamwork and cooperation, problem-solving and decision-making, and leadership and management in complex environments

Surgical Safety Checklist

• Designed an interactive tool using Human Factors principles to structure team communication and assist in ensuring that all team members possess accurate and explicit information regarding the patient and procedural plan, to give team members the same context (situational awareness).

Surgical Team in Action

Progress Assessment

Objectives of the Surgical Safety Checklist Assessment

• Assessment of the Surgical Safety Checklist post implementation

• Quantify the use of the Surgical Safety Checklist in procedures across the region

• Qualify how the tool is being used:– Pieces that provide beneficial information,– Areas that need improvement

• Reconcile documented use to actual use• Identify good catches

Methods

• A multi-faceted evaluation of the Surgical Safety Checklist will occur to collect:– A comprehensive understanding– The effectiveness– Highlight personal experiences

Evaluation Tools

• Observations of surgical procedures– A minimum of 65 surgical cases by 5 observers– Facilities include VGH, UBCH, LGH, RH, SPH & MSJ

• An electronic survey – All surgical staff members across VCH receive an invitation to

participate

• Interviews of front line staff– At minimum, 3 nurses, 3 surgeons, and 3 anesthesiologists from

each facilities.– Nursing graduate student and Human Factors Specialist

interviewers

Assessment Status(February 24th, 2012)

Evaluation Actual

Interviews 24

Observations 35

Electronic Survey 162

Overall Findings1. Differences in the compliance rate verses

perceived completion of the checklist.

2. Every facility observed has incorporated the checklist into their workflow differently.

3. Surgical teams value the checklist

4. Concerns around the entire team ‘buying-in’, increased leadership, responsibility, and simplification of content?

Surgical Safety Checklist Completion

Evaluation Type Overall Briefing Time-Out Debriefing

Interviews(n=24)

84.8% 71.4% 93.4% 54.4%

Observations(n=35)

76.3% Standard Above Standard

Standard

Electronic Survey (n=162)

88.1% 68.6% 93.3% 59.2%

Compliance Score

72.8% (P9 report)

-- -- --

Average Total (all 4 methods)

80.5%

Q3. What parts of the Surgical Safety Checklist have been working well?

Strongest themes:• Antibiotic prophylaxis administration• DVT prophylaxis considerations• Availability of appropriate implants and

equipment • Allergies awareness and confirmation• Overall increased communication in the OR

Q4. What parts of the Surgical Safety Checklist have NOT been working well?

Strongest themes:• Briefing and Debriefing• Lack of awareness and understanding of the

purpose• Attention• Responsibility and accountability• Designates

Best Surgical Safety Checklists Observed to date:

• Dr. Bas Masri (Ortho): Ownership of checklist

• Dr. Ryan Patterson (Urology): Empowering residents

• Dr. Houston (General RH): Conversation Involvement

• Dr. Thompson (Spine LGH): Involvement of patient

 

Good Catches (Electronic Survey Responses)

53 Good Catches / Close Calls (n=162)

Summary of themes:• Antibiotics **• Surgical site and side• Wrong patient• DVT prophylaxis• Equipment, Implants• Blood type and product availability

Q8. Would you want the Surgical Safety Checklist used if you were having surgery?

Areas of Improvement

• Empowering teams to think “critically”

• Supporting leadership, responsibility, and accountability

• Awareness and education on the value of team communication

• Logistics in implementation

Next Steps

• Provide final report and findings to surgical staff and leadership

• Develop recommendations with the team

• Further refine the checklist conversation for improved use

• Complete implementation and assessment of procedural checklists throughout VCH /PHC

ContactAllison Muniak (nee Lamsdale), M.A.Sc – Human Factors Specialist

Quality and Patient Safety, Vancouver Coastal Health

Contact:

Email: allison.muniak@vch.ca

Phone: 1-604-875-4111 extension 66096

Rm 380, Centennial Pavilion

855 West 12th Avenue,

Vancouver, BC, V5Z 1M9

Canada