Patients are at heightened risk of complications while undergoing surgery. The use of a checklist for surgical safety has been utilized to lower these rates of complications. This paper was developed to respond to the question: When health care professionals implement a surgical safety checklist, compared to regular procedure without use of a checklist, do incidence of complications in patients decrease during hospital stay? CINAHL, Pub Med, and the Cochrane Library databases were searched using keywords: checklist, patient safety, surgery, adverse events, and complications for credible publications and retrieved five relevant articles.
One out of the five publications is a systematic review and the other four are cohort studies. Four out of the five included studies concluded that implementation of the surgical safety checklist contributed to significant decrease in the rate of patient complications. One studied was inconclusive and concluded that further research needed to be done to better assess the effectiveness of safety checklists. Research supplied sufficient evidence of lowered complications that supports the use of the surgical safety checklist within hospital surgical units.
Best practice would be to implement the surgical safety checklist into surgical units. The author recommends that mandating surgery teams to complete simulation training with educational proficiency of the checklist to implement the checklist into best practice. Surgical Safety Checklists and Patient Safety Patients undergoing surgical procedures are at a heightened risk for complications and death, although it is unclear whether these risks can be modified with the surgical safety checklist.
The purpose of this paper was to respond in part to the question: When health care professionals implement a surgical safety checklist, compared to regular procedure without use of a checklist, do incidence of complications in patients decrease during hospital stay? The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Pub Med, and the Cochrane Library databases were searched using keywords: checklist, patient safety, surgery, adverse events, and complications. Five credible publications were retrieved and assessed for evidence-based data.
Of the five credible publications retrieved, one was a Level I systematic review (Ko, Turner & Finnigan 2011). The remaining publications were Level III cohort studies (Weiser et al. 2010), (Haynes et al. 2009), (Panesar et al. 2011), and (Zegers et al. 2011). Ko, Turner, & Finnigan (2011) conducted a quantitative systematic review of 9 cohort studies assessing the effectiveness of a safety checklist within acute hospital settings. Trends across all studies were impossible to summarize due to variations in checklist design, setting, given training, and the outcomes measured.
The studies suggest benefits of using safety checklists to improve patient safety, but results should be interpreted with caution due to risks of bias and low level of evidence available. Authors concluded that further research is needed to be able to clearly determine the effectiveness of safety checklists in hospital settings. Weiser, Haynes, Dziekan, Berry, Lipsitz, and Gawande (2010) conducted an applied, longitudinal, quantitative study that measured the effects of a 19-item surgical safety checklist over the rate of patient complications and was approved by the human subjects committees of Harvard School of Public Health and the WHO.
Data of clinical process and outcome was prospectively collected from 1750 patients undergoing urgent noncardiac surgery, consecutively admitted within 8 varied hospitals around the world and analyzed with SAS 9. 1 statistical software package. The rates of complications and deaths dropped (18. 4% to 11. 7% [P=0. 0001] and 3. 7% to 1. 4% [P=0. 0067] respectively) after introduction of the checklist. Authors concluded that the implementation of the 19-item WHO Surgical Safety Checklist reduces complications by one-third and should be implemented in urgent noncardiac operations.
Haynes et al. (2009) conducted an applied, longitudinal, quantitative study measuring the effect of 2-step WHO surgical safety checklist over patients complication rates and was approved by the human subjects committees of Harvard School of Public Health and the WHO. Prospectively collected data was obtained from a total of 7688 urgent noncardiac surgery patients within 8 diverse hospitals around the world and analyzed with SAS 9. 1 statistical software package.
The rates of inpatient complications, surgical site infections, and deaths dropped (11. % to 7. 0% [p<0. 001], 6. 2% to 3. 4% [p<0. 001], and 1. 5% to 0. 8% [p=0. 003] respectively) after introduction of the checklist. Authors concluded that the implementation of the 2-step WHO Surgical Safety Checklist is associated with reduction in patient complications and should be globally adopted into surgical practice. Zegers et al. (2011) conducted an applied, cross-sectional, quantitative study measuring the cause and the degree of prevention over surgical adverse events (AEs).
Retrospective data was collected from random sampling of 7926 patient records within 21 different Dutch hospitals and reviewed for AEs by 2 expert panels then further analyzed with SPSS 14. 0 statistical software program. Study findings of surgical AEs accounted for 3. 6% of overall hospital admissions and represented 65% of all AEs. Causation of 65% of the surgical AEs was due to human factors that were considered to be preventable through interventions.
Authors concluded that consequences of surgical AEs compared to other AEs are more severe in consequences, more frequently occurring, and more often preventable through human-directed interventions. Panesar et al (2011) conducted an applied, cross-sectional, quantitative study measuring degree of prevention if had utilized the surgical safety checklist over wrong site orthopaedic surgeries. 2008 NRLS database was searched and retrieved 133 patient records fitting the criteria for retrospective data collection.
Expert panels assessed records for preventability of incident with a 0. 97 inter-rater reliability rate. Findings revealed 9% of the incidence cases produced actual harm and 83. 3% (95% CI) of those cases were considered preventable if the checklist. The authors conclude that using tools such as the WHO Surgical Safety Checklist would increase the rate of patient safety in orthopaedic surgery. The purpose of the paper was to determine whether healthcare implementation of surgical safety checklist would decrease the rate of patient complications during hospital stay.
As noted above, four out of the five research studies concluded that implementation of the surgical safety checklist contributed to decreasing the rate of patient complications. One studied concluded that further research needed to be done to be able to assess the effectiveness of safety checklist. Best practice would be to implement the surgical safety checklist into practice of surgical procedures. Healthcare professionals are especially strapped for time due to patient loads and responsibility and may be more inclined to cut corners around the checklist if in a hurry. Healthcare professionals are also evidence-based orientated.
In this author’s clinical judgment implementing best practice should include methods to increase speed of checklist and to increase knowledge of supporting evidence. Based off of author’s clinical judgment surgical units should mandate seminars or information packet informing all healthcare professionals of evidence surrounding the surgical safety checklist prior to implementing. Surgical team simulation training should be implemented into surgical units within hospital settings to help familiarize surgical team to the procedure and therefore quicken rate of execution and increase confidence in utilizing the tool.
Healthcare organizations adopting or adapting safety checklists into practice should develop a plan of evaluation and publish findings to further add to the body of evidence. Patients undergoing surgical procedures are at a heightened risk for complications, the purpose of this paper is to determine whether surgical safety checklist could modify those complications; research supported the utilization of the surgical safety checklist with recommendations for best practice implementation developed and offered in above paragraphs.