Call 2: Background of the WHO Surgical Safety Checklist

Last Week’s Call• Overview of the Safe Surgery 2015: South

Carolina Initiative and call series.

• MUSC’s checklist journey.

Today’s Topics• Building an implementation team.

• Poll

• The background of the WHO Surgical Safety Checklist.

• Website Overview.

Meeting the Team

Lorri Gibbons, RN, BSN, CPHQVice President

Quality & Patient SafetySCHA

Starting the Journey:Building a Checklist

Implementation Team

Build an Implementation Team

• Administrator/Quality Improvement Officer

• Anesthesiologist and/or CRNA

• Circulating Nurse

• Scrub Tech

• Surgeon

• Others (Perfusionists, PA’s, Biomedical Engineers, Anesthesia Techs, Pre-op nursing, etc)

Find Clinical Champions• The nurses will know.

• Pick those who are respected and who will be supportive.

• The support of “formal” leadership is absolutely necessary but those leaders are often not the ones who should guide this effort directly.

Recommendations on How Often and When to Meet as a Team

• Meet regularly.• Choose someone to organize the meeting

schedule and be a point of contact for people in your hospital and our team.

• An opportune time to meet together would be following each webinar.

• It is better to meet with part of the group than not at all.

Poll 1:Pick the most important thing that

makes you feel like a case went well.• Respected• My concerns were heard• We had all of the necessary equipment• There were not any delays• All of the paperwork was in order• There were no wasted resources• I had all of the information that I needed to know to take

care of the patient• The team worked well together• The case ended on time

Poll 2:Pick all of the things that make a case

go well.• Respected• My concerns were heard• We had all of the necessary equipment• There were not any delays• All of the paperwork was in order• The patient did well• There were no wasted resources• I had all of the information that I needed to know to take

care of the patient• The team worked well together• The case ended on time

Development of the WHO Surgical Safety

Checklist

The ProblemThe Problem

The 3 Central Problems in Surgical Safety Throughout the World

• Unrecognized as public health issue

• Lack of data on surgery and outcomes

• Even though we know what to do, but we don’t do it consistently

Global Annual Procedure Rates

Source: WHO, 2008

Four Categories for Surgical Standards:

CONTROL OF INFECTION AND

CONTAMINATION

ANESTHESIA AND PATIENT

MONITORING

SURGICAL OPERATOR QUALITY ASSURANCE

The Safe Surgery Saves Lives The Safe Surgery Saves Lives ProgramProgram

Guiding Principles• Simple

• Widely applicable

• Measurable

• Address serious and avoidable surgical complications

• Zero harm from the Checklist

Pilot Study

London, UK EURO EMRO

WPRO I

SEARO

AFRO

PAHO I

Amman, JordanToronto, Canada

New Delhi, India

Manila, Philippines

Ifakara, TanzaniaWPRO II

Auckland, NZ

PAHO II

Seattle, USA

International Pilot Study 8 Evaluation Sites - Nearly 8,000 Patients

Results – All SitesBaseline Checklist P value

Cases 3733 3955 -

Death 1.5% 0.8% 0.003

Any Complication 11.0% 7.0% <0.001

SSI 6.2% 3.4% <0.001

Unplanned Reoperation 2.4% 1.8% 0.047

Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229)

The checklist was easy to use 78.6%

The checklist improved operating room safety

79.0%

The checklist took a long time to complete 18.3%

Communication was improved through use of the checklist

84.3%

The checklist helped prevent errors in the operating room

78.2%

If I were having an operation, I would want the checklist to be used

92.6%

The Checklist – September 2006 to December 2009

Quite a trip

SURPASS Checklist The Netherlands

• 100 item checklist implemented in 6 high performing hospitals

• Compared to controls the test hospitals had a greater than one-third reduction in complications and achieved an almost 50% reduction in deaths (from 1.5% to 0.8%)

(N=7,580)

de Vries EN, et al. Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med 2010; 363:1928-1937

Veterans Health Affairs• Implemented a surgical team training program

incorporating a modified version of a surgical checklist in the operating theatres of 74 facilities

• Experienced a mortality reduction of 18%

Neily J, Mills PD, et al. Association Between Implementation of a Medical Team Training Program. JAMA. 2010 Oct 20;304(15):1693-700

Teamwork&

Communication

Site CBaseline

(n=524)Checklist

(n=598)Abx Given 0-60 Mins Except Dirty Cases

98.1% 96.9%

Adherence to All Six Safety Indicators

94.1% 94.2%

SSI 4% 2.0%*Death 1.0% 0.0%*Any Complication 11.6% 7.0%*

*p<0.05

JC/Standard of Practice

WHO/SC Checklist

SCIP

Safe Surgery 2015 Website Tour

www.safesurgery2015.org

Homework

• Build an implementation team.

• Schedule a time and a venue for a meeting to take place after January 23rd. This meeting is where the implementation team will be able to talk to as many OR physicians and staff as possible about the checklist at your hospital.

?Questions

Next Week’s Topic:Measuring the Culture in Your Operating Rooms

Office Hours:Cancelled

Happy Veterans Day

Resources

Website:www.safesurgery2015.org

Email: safesurgery2015@hsph.harvard.edu