World Health Organization Surgical Safety Checklist Modification: Do Changes Emphasize Communication and Teamwork?

Ian Solsky, William Berry, Lizabeth Edmondson, Janaka Lagoo, Joshua Baugh, Alex Blair, Sara Singer, Alex B. Haynes

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. Methods: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. Results: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's “Anticipated Critical Events” section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. Conclusions: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's “Anticipated Critical Events” section.

Original languageEnglish (US)
Pages (from-to)614-622
Number of pages9
JournalJournal of Surgical Research
Volume246
DOIs
StatePublished - Feb 2020

Fingerprint

Checklist
Communication
Safety
Nurse Anesthetists
Safety Management
Venous Thrombosis
Nurses
Equipment and Supplies

Keywords

  • Implementation
  • Intervention fidelity
  • Surgical safety checklists

ASJC Scopus subject areas

  • Surgery

Cite this

World Health Organization Surgical Safety Checklist Modification : Do Changes Emphasize Communication and Teamwork? / Solsky, Ian; Berry, William; Edmondson, Lizabeth; Lagoo, Janaka; Baugh, Joshua; Blair, Alex; Singer, Sara; Haynes, Alex B.

In: Journal of Surgical Research, Vol. 246, 02.2020, p. 614-622.

Research output: Contribution to journalArticle

Solsky, Ian ; Berry, William ; Edmondson, Lizabeth ; Lagoo, Janaka ; Baugh, Joshua ; Blair, Alex ; Singer, Sara ; Haynes, Alex B. / World Health Organization Surgical Safety Checklist Modification : Do Changes Emphasize Communication and Teamwork?. In: Journal of Surgical Research. 2020 ; Vol. 246. pp. 614-622.
@article{2d908f0756e64fd9835874d1a756a54c,
title = "World Health Organization Surgical Safety Checklist Modification: Do Changes Emphasize Communication and Teamwork?",
abstract = "Background: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. Methods: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. Results: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84{\%}), deep vein thrombosis prophylaxis/anticoagulation (added by 75{\%}), and positioning (added by 63{\%}). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75{\%}), followed by 4 items (each removed in 39{\%}-48{\%}) that comprise part of the WHO Checklist's “Anticipated Critical Events” section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12{\%}; the anesthesiologist/certified registered nurse anesthetist in 14{\%}, the circulator in 10{\%}, and the surgical tech/scrub in 79{\%}. Conclusions: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's “Anticipated Critical Events” section.",
keywords = "Implementation, Intervention fidelity, Surgical safety checklists",
author = "Ian Solsky and William Berry and Lizabeth Edmondson and Janaka Lagoo and Joshua Baugh and Alex Blair and Sara Singer and Haynes, {Alex B.}",
year = "2020",
month = "2",
doi = "10.1016/j.jss.2018.09.035",
language = "English (US)",
volume = "246",
pages = "614--622",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - World Health Organization Surgical Safety Checklist Modification

T2 - Do Changes Emphasize Communication and Teamwork?

AU - Solsky, Ian

AU - Berry, William

AU - Edmondson, Lizabeth

AU - Lagoo, Janaka

AU - Baugh, Joshua

AU - Blair, Alex

AU - Singer, Sara

AU - Haynes, Alex B.

PY - 2020/2

Y1 - 2020/2

N2 - Background: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. Methods: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. Results: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's “Anticipated Critical Events” section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. Conclusions: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's “Anticipated Critical Events” section.

AB - Background: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. Methods: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. Results: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's “Anticipated Critical Events” section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. Conclusions: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's “Anticipated Critical Events” section.

KW - Implementation

KW - Intervention fidelity

KW - Surgical safety checklists

UR - http://www.scopus.com/inward/record.url?scp=85054688323&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054688323&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2018.09.035

DO - 10.1016/j.jss.2018.09.035

M3 - Article

AN - SCOPUS:85054688323

VL - 246

SP - 614

EP - 622

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -