Call 2: Background of the WHO Surgical Safety Checklist
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Transcript of Call 2: Background of the WHO Surgical Safety Checklist
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