575 / Implementation of the surgical safety checklist: assessment of impact on morbi-mortality rate and perceptions of its usefulness for the professionals

Type of Patient Safety Practice NOT PROVEN EFFECTIVE
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Surgical / Invasive procedures
Handover situations / Transfer of patients
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
We have implemented a surgery checklists developed to enhance teamwork and improve handover, thereby minimizing avoidable errors and complications including mortality. Therefore, the implementation of this practice pretends to reduce surgical complications including mortality of the patients that have had a surgical operation in our hospital.
Description of the Patient Safety Practice
Checklists are cognitive aid for certain activities. It has been proven effective both in the proper execution of certain activities and the prevention of errors because they serve to systematize the actions. Although they have been widely used for a long time in many sectors (aeronautics, etc.) its use in the health sector has been recent. WHO designed in 2008 a checklist to improve surgical patient safety. Since then, organizations all over the world have implemented it.

In 2009 the Surgical Commission with the support of the Preventive Medicine and Quality Management Department adapted the checklist to our center taking into account the recommendations of the WHO. Unlike the WHO protocol, our checklist indicates the professional who is responsible for verifying each of the items and left a written record thereof. The checklist has 38 items, the verification starts at the nurse ward before the surgical intervention.

The implementation of the surgical checklist was piloted in the department of Trauma and Vascular Surgery in March 2009. The level of completeness of the listing was evaluated and the results were presented to the Surgical Commission.
In view of the results and in order to have the clues to deploy the checklist to the whole hospital, it was decided to perform different actions.

The fist one was to design a questionnaire to know the opinion of the professionals involved in the completion of the checklist. 78 professionals from Trauma and Vascular Surgery Departments answered the questionnaire (response rate 72%).

Secondly, training activities were organized on agreed schedules (morning and evening) with all nursing wards and medical departments involved. The teaching team was multidisciplinary: surgeon, anesthesiologist, nurse and physician from the Preventive Medicine Department. The sessions were accredited by the Continuing Education Committee. There were 21 teaching sessions. The number of people who completed training evaluation was 191 while the number of attendees was higher. In the assessments, the mean score on overall satisfaction and the application of acquired knowledge to work was 7,2 points (range 0-10).

Thirdly, annual evaluation of the degree of implementation was performed. Professionals have completed the checklist in 87% of surgical interventions. In 2011, this percentage dropped to 79%. In 2012, this figure rebounded somewhat to stand at 85%. The percentage of checked items evaluated was 88% in 2010, and 79% in 2011 and 2012.

However, the main evaluation of the checklist implementation was, on the one hand, to analyze its effectiveness in terms of complications and mortality before and after the implementation of the checklist and, on the other hand, to know the perception of the health care professionals about the degree of implementation and the usefulness of the Surgical Safety Checklist after its implementation.

In 2010, after four months of implementation of the checklist, questionnaires were sent to 249 professionals from all surgical services directly involved in completing the checklist (response rate 73%). The questionnaire contained 11 items plus four control variables.

In 2012 the effectiveness of the checklist was evaluated. 23 surgical complications were measured in 1104 patients operated in 2008 and 1071 patients operated in 2010.

Attachment of relevant written information and/or photos, as appropriate
Effectiveness of the Patient Safety Practice
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
A baseline measurement before implementation of the reported practice was obtained
A measurement after full implementation of the reported practice was obtained
Evaluation of a “positive” effect of the reported practice on Patient Safety
The evaluation showed no effect in Patient Safety outcomes
Type of before-and after evaluation
Enclosure of a reference or attachment in case of published evaluation’s results
We are going to publish the results of the effectiveness in terms of complications and mortality.
We have published the results of the professional perceptions.
The healthcare professional’s perceptions on the implementation and usefulness of the surgical safety checklist. Rodrigo-Rincón MI, Tirapu-León B, Zabalza-López P, Martín-Vizcaino MP, de La Fuente-Calixto A, Villalgordo-Ortín P, Domench-Manero L, Gost-Garde J.
Rev Calid Asist. 2011 Nov-Dec;26(6):380-5. doi: 10.1016/j.cali.2011.03.005. Epub 2011 May 14. Spanish.
Health care context where the Patient Safety Practices was implemented
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation’s level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
Scientific staff / researchers
Administrative support (secretary, clerk, receptionist etc.)
Quality manager
Risk manager
Patient Involvement
Direct service user’s involvement as integral part of this Patient Safety Practice
Specification of the service users or their representatives’ involvement in the implementation of this Patient Safety Practice
Point of time in which service user or their reprasentatives’ involvement takes place
During implementation of the Patient Safety Practices
Active seeking of service users’ opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Short description of the service users’ level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
List of sources where public information is accessible
Implementation of the Patient Safety Practice
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
No motivation among staff
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Description of used incentives, if any.
The degree of implementation of the checklist is part of the objectives that management negotiates with clinical services.
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Costs of the Patient Safety Practices
Completion of cost calculation related to this Patient Safety Practice
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here