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In 2010, following the recommendations of the World Health Organization (WHO), our hospital implemented a surgical safety programme centred around a surgical safety checklist.The aim of this study was to compare indicators of surgical site infection, antimicrobial consumption, antimicrobial resistance, costs and in-hospital mortality before (January 2006 to July 2010) and after (August 2010 to December 2014) implementation of the programme.A case-control study was carried out matching patients with surgical site infection (SSI) to surgical patients without infection to examine the impact of the intervention.Use of the surgical checklist was associated with a significant reduction in SSI. When comparing the two time periods, we also identified a reduction in infections due to micro-organisms in the ESKAPE group (from 90.7% to 73.9%, P0.001), a reduction of SSI in patients with contaminated, infected and potentially contaminated wounds, and for those in whom perioperative antimicrobial prophylaxis was discontinued in less than 48 hours. Overall, there was a reduction in antimicrobial resistance, though there was increased resistance to carbapenems for, to glycopeptides for Enterococcus faecium, and to clindamycin for Staphylococcus aureus. We also detected increased antimicrobial consumption of second- and third-generation cephalosporins and clindamycin. We observed a reduction in hospital deaths from 6.4% to 3.2% (P=0.001), but we did not observe any reduction in costs.Implementation of a surgical checklist was an independent predictor of SSI reduction, and was also associated with a decrease in antimicrobial resistance and reduced in-hospital mortality.

Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.

BACKGROUND Surgeons administer care in an increasingly complex clinical environment. Time constraints put strain on individual clinicians and the multidisciplinary team, increasing the risk of human errors. The World Health Organization surgical checklist has shown to mitigate this risk perioperatively. We describe the development, introduction and outcomes of a novel ward round safety checklist. METHODS The vascular team ward rounds at Christchurch Hospital were assessed over a 2-week period for ward round quality indicators. A ward round safety checklist was developed and then introduced. Two further assessments were conducted to evaluate for improvement in the ward round quality indicators. Ward rounds were timed with the length of each consultation recorded and staff perception assessed. RESULTS Significant gains across both clinical indicators and staff feedback measures were observed. Of the 21 ward round quality indicators, 20 showed statistically significant improvement, as did all subjective measures. Significant improvements included observation chart review (20% to 75% to 81%), drug chart review (10% to 54% to 78.6%) and anticoagulation/antiplatelet treatment (32% to 61% to 58.1%) (P

Resumo Objetivo Analisar o impacto das ações educacionais inseridas na campanha “Considere o Risco”, da Sociedade Brasileira de Traumatologia e Ortopedia (SBOT), para aumentar a percepção do risco envolvido na atividade cirúrgica e a utilização do checklist cirúrgico. Métodos Realização de pesquisa comparativa, durante o 50° Congresso Brasileiro de Ortopedia e Traumatologia (50° CBOT), em novembro de 2018, utilizando questionário semelhante ao de duas versões anteriores. Resultados O número de participantes foi de 730, correspondendo à 18,7% do total de 3903 inscritos no 50° CBOT. No total, 542 ortopedistas (74,2%) relataram já ter vivenciado erros dentro do centro cirúrgico e 218 (29,8%) cirurgias em locais errados; 624 participantes (85,5%) afirmaram marcar o local da cirurgia e 402 (55%) utilizar regularmente o checklist cirúrgico. Conclusão Na amostra pesquisada, ficou evidenciado que os esforços da SBOT para a disseminação do conhecimento do protocolo da Organização Mundial de Saúde (OMS) foram efetivos, reduzindo a quantidade de ortopedistas que o desconheciam de 65,3% (em 2012) para 20,7% (em 2018), e ampliando sua utilização. Em 2018, 402 ortopedistas (55% da amostra) referiram fazer uso frequente do protocolo no ambiente cirúrgico, em comparação com 301 (40,2%) em 2014. Estes dados confirmam a necessidade de campanhas educacionais e treinamentos sistemáticos, não apenas para promover uma mudança de comportamento, como também, principalmente, uma mudança cultural.

Medicine since its inception has continued to evolve. The past few decades have seen many specialties branching out. This is been to the increasingly complex nature of the field consequent to advances in technology and understanding of the human body. In addition to advancing technology, there is a relatively recent focus on safety. Studies have shown that there are a significant number of errors with serious consequences that occur among surgical patients. Many of these errors are preventable. Several factors play a role which includes nontechnical aspects such as human factors. This is most evident in high-pressure complex situations such as an operating theatre. This prompted the World Health Organization (WHO) to take up global patient safety challenges. With the motto of “Safe Surgery saves lives,” the WHO has undertaken numerous regional and global initiatives to improve patient safety and pioneered the implementation of the surgical safety checklist. Patient safety has evolved as an important part of surgical practice. This article presents a brief narrative of the development of patient safety in the surgery, its expansion, and future direction.

We implemented the World Health Organization surgical safety checklist at Auckland City Hospital from November 2007. We hypothesised that the checklist would reduce postoperative mortality and increase days alive and out of hospital, both measured to 90 postoperative days. We compared outcomes for cohorts who had surgery during 18-month periods before vs. after checklist implementation. We also analysed outcomes during 9 years that included these periods (July 2004-December 2013). We analysed 9475 patients in the 18-month period before the checklist and 10,589 afterwards. We analysed 57,577 patients who had surgery from 2004 to 2013. Mean number of days alive and out of hospital (95%CI) in the cohort after checklist implementation was 1.0 (0.4-1.6) days longer than in the cohort preceding implementation, p

Purpose To investigate whether the World Health Organization Safety Surgical Checklist (SSC) is an effective tool to reduce complications in spinal surgery. Methods We retrospectively evaluated the clinical and radiological charts prospectively collected from patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist’s effectiveness. Results The sample size was 917 patients with an average of 30-month follow-up. The mean age was 52.88 years. The majority of procedures were performed for oncological diseases (54.4%) and degenerative diseases (39.8%). In total, 159 complications were detected (17.3%). The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. No correlation was observed between the type of pathology and the complication incidence. We observed a reduction in the overall incidence of complications following the introduction of the SSC: In 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%). Conclusions The SSC seems to be an effective tool to reduce complications in spinal surgery. We propose to extend the use of checklist system also to the preoperative and postoperative phases in order to further reduce the incidence of complications. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Background Although 1 in 59 children currently born are diagnosed with autism spectrum disorder (ASD), little is known on how to best manage those patients who require surgical intervention. The purpose of this study is to (1) investigate the best care strategies for surgical patients living with autism spectrum disorder (2) provide recommendations on how to apply those strategies to clinical practice. Methods A literature review was conducted to investigate the best clinical practices for optimizing surgical care for individuals living with autism spectrum disorder. Relevant articles were selected and examined, and individual references from those articles were manually searched using Ovid Medline and Google Scholar. Results The wide spectrum of symptoms associated with autism spectrum disorder pose unique challenges for surgical management. Early coordination with the patient and family optimizes the development of an effective care plan. Strategies include identifying triggers for anxiety as well as soothing mechanisms, performing surgery in the morning, completing preoperative paperwork prior to surgery, choosing appropriate analgesia and anxiolytics, and fast resumption of normal routines. Based on these findings a surgical checklist was created to aid in treating the patient with autism spectrum disorder. The checklist provides insight into navigating the surgical experience and emphasizes planning surgical interventions to most effectively fit individual patient needs. Conclusion The surgical treatment of those living with autism spectrum disorder poses unique challenges for the health care team. The widespread adoption of such individualized approaches encompassing pre/intra/post-operative will become more important as these children grow into adults with increased needs for surgical services., Highlights • Early coordination optimizes development of an effective care plan. • Identifying triggers for anxiety as well as soothing mechanisms can be helpful. • Performing surgery first in the morning decreases deviation from normal routines. • Completing preoperative paperwork prior to surgery reduces surgical day work. • Choosing appropriate analgesia and anxiolytics assists in surgical interventions.

Background The World Health Organization (WHO) surgical checklist is associated with reduced morbidity and mortality. Efficacy correlates with compliance. Objective This study aims to (1) establish completion rate and (2) identify and address barriers to use. Methods Records of patients undergoing dermatological surgery were studied. Staff completed attitude and barriers questionnaires. Checklist process was modified, and use was reassessed twice. Results Cycle 1 involved 217 subjects; 72% had excisions. Thirteen percent had surgery to multiple sites. Five percent of checklists were fully completed, with an average of 76% of available points per checklist marked as checked. The lowest single field use included "patient identity" (76%) and "surgical site" (72%). Questionnaire responses from 25 staff showed the checklist to be "important" and "relevant" in dermatology; key barrier to completion was lack of time. Checklist modifications and educational sessions were undertaken; checklist use was reassessed twice more with 103 and 134 patients. Average use increased to 96% and 98%; full completion increased to 71% and 70%; "surgical site" and "identity" completion increased to 100%. Conclusion The WHO checklist is relevant and important in dermatology. Introduction must be supported by repeated training sessions. Adequate time and training can significantly improve checklist completion and patient safety.

Purpose of review Conventional transurethral resection (TURBT) with tumor fragmentation is the primary step in the surgical treatment of nonmuscle invasive bladder cancer. Recently, new surgical techniques and training modalities have emerged with the aim to overcome short-comings of TURBT and improve oncologic outcomes. In this review, we provide a comprehensive update of recent techniques/techniques that aim to improve upon conventional TURBT and beyond. Recent findings A systemic approach during conventional TURBT that features the use of a surgical checklist has been shown to improve recurrence-free survival. Several simulators have been developed and validated to provide additional training opportunities. However, transfer of improved simulator performance into real world surgery still requires validation. While there is no convincing data that demonstrate superior outcomes with bipolar TURBT, en-bloc resection already promises to offer lower rates of complications as well as potentially lower recurrence probabilities in select patients. Summary TURBT remains the quintessential procedure for the diagnosis and treatment of bladder cancer. Urologists need to be aware of the importance and challenges of this procedure. Aside of embracing new resection techniques and a conceptual-systematic approach, training opportunities should be expanded upon to improve patient outcomes.

This chapter provides an overview of the clinical and radiological features of otosclerosis. All important radiological features are highlighted with appropriate imaging examples. Potential differential diagnosis and pitfalls are explained along with a detailed surgical checklist highlighting the relevant points that need to be included in a practical report.

OBJECTIVE To elucidate the therapeutic benefits of using a surgical checklist during transurethral resection for non-muscle-invasive bladder cancer. METHODS A nine-item surgical checklist was established in January 2016 to assess disease risk and resection adequacy, and it was prospectively implemented into clinical practice. Patients diagnosed with non-muscle-invasive bladder cancer who underwent complete resection from January 2009 to August 2019 were included in this study. The presence of detrusor muscle in the transurethral resection specimen and the intravesical recurrence-free survival were compared between patients who underwent transurethral resection before and after surgical checklist implementation. RESULTS A total of 125 patients who underwent transurethral resection after surgical checklist implementation were reviewed and compared with 125 patients who underwent transurethral resection before surgical checklist implementation. The use of the surgical checklist led to an increase in the proportion of transurethral resection specimens containing detrusor muscle (92% vs 69.6%, P

Background: Surgical checklist was introduced by the World Health Organization to reduce the number of surgical deaths and complications. During a surgical conference on “safety in surgical practice,” it was noticed that the awareness and the use of surgical checklist are poor in Nigerian hospitals. This study was aimed at determining the awareness and use of surgical checklist among the theater users in our hospital, factors militating against its implementation, and make recommendations. Methods: This is a prospective study at Ekiti State University Teaching Hospital, Ado-Ekiti; questionnaires were distributed to three groups of theater users – surgeons, anesthetists, and perioperative nurses. The responses were collated by the lead researcher, entered into Microsoft Excel spreadsheet, exported, and analyzed with SPSS. Results: Eighty-five questionnaires were distributed, 70 were returned, and 4 were discarded due to poor filling. The studied 66 comprised 40, 12, and 14 surgeons, anesthetists, and perioperative nurses, respectively. Fifty-five (83.3%) of the responders indicated awareness of the checklist but only 12 (21.8%) correctly stated that the main objective is for patients’ safety and for safe surgery. Major barriers to its use include lack of training 58.2%, lack of assertiveness of staff 58.2%, and that its delays operation list 47.2%. Conclusion: The study demonstrated high level of awareness of surgical checklist in our hospital; however, this awareness is based on wrong premises as it is not reflected in the true aim of the checklist. Majority of the responders would want to be trained on the use of checklist despite the highlighted barriers.

Urothelial carcinoma at bladder is the 9th most common malignancy worldwide (1). It is the second most common malignancy in the urologic tract (2). According to GLOBOCAN data, 165,000 bladder cancer death occurred in 2012 worldwide (3). The clinical behavior of bladder urothelial carcinoma is quite different depending on the presence of muscle layer invasion.

Background The World Health Organization (WHO) Surgical Safety Checklist is used globally to ensure patient safety during surgery. Two years after its implementation in the University Hospital Basel’s operating rooms, adherence to the protocol was evaluated. Methods This mixed method observational study took place in the surgical department of the University Hospital of Basel, Switzerland from April to August 2017. Data collection was via individual structured interviews with selected OR team members regarding checklist adherence and on-site non-participant observations of Team Time Out and Team Sign Out sequences in the OR. Data were subjected to thematic analysis and descriptive statistics compiled. Results Comprehensive local expert interviews indicated that individual, procedural and contextual variables influenced the application of the checklist. Facilitating factors included well-informed specialists who advocated the use of the Checklist, as well as teams focused on the checklist’s intended process and on its content. In contrast, factors such as staff insecurity, a generally negative attitude towards the checklist, a lack of teamwork, and hesitance to complete the checklist, hindered its implementation. The checklist’s application was evaluated in 104 on-site observations comprising of 72 Team Time Out (TTO) and 32 Team Sign Out (TSO) sections. Adherence to the protocol ranged between 96 and 100% in TTO and 22% in TSO respectively. Lack of implementation of the TSO was mainly due to the absence of one of the key OR team members, who were busy with other tasks or no longer present in the operating room. Conclusion The study illustrates factors, which foster and hinder consistent application of the WHO surgical safety checklist namely individual, procedural and contextual. It also demonstrates that the TTO was consistently and correctly applied, while the unavailability of key OR team members at sign-out time was the most common reason for omission or incomplete use of the TSO.

A surgical checklist is a step-by-step control procedure carried on for checking through the most delicate phases of the perioperative period, in order to increase surgical patient’s safety and avoid preventable complications. The checklist implementation within operating rooms have proved to be effective in reducing morbidity and mortality rates significantly, without being costly and lengthy. These results have been confirmed also in emergency surgery, which represents in itself a cause of higher risks for patients. Thus, the checklist use has rapidly spread out all over the world. The mechanism responsible for the improvement of surgical outcomes is not completely clear, partly due to ameliorated perioperative practices and better communication among surgical team members. This chapter reports a general overview on this theme and describes the way of using the World Health Organization (WHO) Surgical Safety Checklist (SSC), which is by far the most common surgical checklist worldwide. A curious historical reference concerning the development of checklists in aviation is also provided, helping understand the logic behind their application to the surgical field. Moreover, this chapter reports some useful paragraphs concerning technical considerations, notably the necessary equipment in colorectal surgery, patient positioning and ports placement.

Objectives To evaluate the impact of an eight-item surgical checklist (SC) on the recurrence-free survival (RFS) of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumour (TURBT). Patients and methods A group of urologists at two tertiary referral centres, with expertise in bladder cancer, identified eight critical items that should be performed in every high-quality TURBT. An eight-item SC was prospectively implemented into clinical practice and the operative reports of TURBTs performed before and after implementation were reviewed. Results from both institutions were combined to estimate the impact of introducing the SC on oncological outcomes. Multivariable logistic and Cox hazards regression analyses were performed to evaluate the impact of the SC on the presence of detrusor muscle in the TURBT specimen and on RFS, respectively. Results The operative reports of 266 TURBTs performed after the SC implementation were reviewed and compared to those of 281 TURBTs performed prior to the SC introduction. The SC was independently associated with a significant improvement in RFS (P = 0.02). However, the introduction of the SC was not significantly associated with the presence of detrusor muscle in the surgical specimen (P = 0.4). Conclusion The use of an eight-item SC during TURBT in clinical practice increases the quality of operative reports thereby potentially improving individualised risk-stratification and care resulting in lower disease recurrence rates. Therefore, the introduction of a SC can be recommended to enhance oncological outcomes by improving surgical standardisation and operative reporting.

Background Suboptimal communication can lead to preventable preoperative delays. In our study, we aimed to identify factors delaying surgery in the immediate preoperative period. Our outcomes of interest were the anesthesia release to incision time (RIT) and preoperative expectations of neurosurgery and anesthesia providers. Additionally, we introduced new communication goals prior to induction, to examine the impact on preoperative efficiency. Methods The study is a prospective cohort analysis evaluating communication in the immediate preoperative period. In 42 consecutive cranial neurosurgical cases, a questionnaire was given to neurosurgical and anesthesia providers, and their responses were recorded. Halfway through this study, a formal pre-induction checklist was implemented that included expected duration of surgery, expected blood loss, surgical positioning, and intraoperative medication requirements. Results Comparing the cohorts before and after implementing the checklist, no difference in release to incision time was observed. However, the difference in estimated procedure time was significantly decreased after implementation of the formal pre-induction checklist. Further, there was a trend towards better agreement in estimated blood loss, although results did not achieve statistical significance. These delays all demonstrated a statistically significant decrease after the new communication goals were executed. Conclusion While no statistically significant change in release to incision time was uncovered during our study, there was evidence that communication between teams improved after implementation of the checklist. Additionally, we observed less discrepancy in estimated case length and blood loss, suggesting focused communication goals aligned expectations of the neurosurgical and anesthesia teams.

Introduction: Complications during eyelid and periorbital surgery can result in a poor post-operative outcome. Prevention and early recognition of complications is key to a good outcome.Areas covered: The published literature with the terms “complications of oculoplastic/ptosis/ blepharoplasty surgery, anticoagulation, patient satisfaction, psychosocial cosmetic surgery, surgical checklist and local/ophthalmic/general anesthesia” were searched using PubMed. Preoperative patient evaluation, discussion of patient's desired outcomes, practical considerations of operating scheduling and operating theatre management are highlighted. Tips on management of the anti-coagulated patient, patient positioning and anaesthesia, optimal surgical techniques and preventable complications of eyelid surgery will be discussed.Expert commentary: Knowledge of possible surgical complications that may occur enables the surgeon to prepare for and confidently prevent them.

BACKGROUND:There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality.OBJECTIVE:The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer.DESIGN:A consensus-oriented decision-makin

Background and aims The World Health Organisation (WHO) surgical checklist acts as a safety check before surgery. The three components are: sign in, surgical pause and sign out. This study aims to assess and improve the surgical pause at a tertiary paediatric surgical unit. Methods and results Theatre nurses used as a standardised tool to record how the pause was carried out. All other theatre staff were blinded. Presentation of these data at departmental meetings allowed creation of a checklist poster which was placed in every theatre. Data collection was repeated five months later. Data on 114 operations were initially collected. Fifty-one per cent of operations completed all four steps to guideline. Introduction step met guideline in 61% of operations, identity and procedure in 90%, checklist in 98% and concerns in 71%. Following intervention, data were collected from 39 operations; 77% of operations completed all four steps to guideline. Introduction step met guideline in 87% of operations, identity and procedure in 100%, checklist in 100% and concerns in 90%. Conclusions This study shows that by engaging with theatre staff to create an acceptable checklist poster, better standard of patient safety in the operating theatre can be achieved.

Objective: To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. Background: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. Methods: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. Results: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37–0.87, P < 0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. Conclusions: Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.

Purpose To compare the mortality, reoperation, and readmission rates before and after the implementation of a surgical checklist in Brazil and Canada. Design An epidemiological, retrospective study was conducted. Methods Preimplementation and postimplementation data were collected via patient chart reviews to determine mortality, reoperation, and readmission rates. Findings In Brazil, a decrease in readmission rate from 2.9% to 1.7% (P = .518) was observed after the implementation of the checklist. In Canada, reoperation rate decreased from 5.6% to 4.8% (P = .649) and mortality from 1.7% to 0.9% (P = .407) after implementation. In the Brazilian institution, patients with incomplete checklists had increased rates of readmission, from 1.4% to 2.4% (P = .671), and reoperation, from 6.8% to 10.4% (P = .232). Conclusions The use of surgical checklist did not translate into improvements in the outcomes studied after its implementation in any of the scenarios evaluated. This result is possibly justified by the socioeconomic structure of each of these settings.

The adoption of a surgical checklist is strongly recommended worldwide as an effective practice to improve patient safety; however, several studies have reported mixed results and a number of issues are still unresolved. The main objective of this study was to explore the impact of the first 5-year period of a surgical checklist-based intervention in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public hospitals between 2006 and 2014. The adherence to the checklist was measured between 2011 and 2013 through a computerized database. The effects of the intervention were explored through multivariable logistic regression and difference-in-differences (DID) approaches, based on current administrative data sources. In-hospital and 30-days mortality, 30-days readmissions and length-of-stay (LOS) ⩾8 days were the observed outcomes. Adherence to the checklist showed marked variations across hospitals (0%-93.3%). A pre/post analysis detected statistically significant differences between surgical interventions performed in hospitals with higher adherence to the checklist (⩾75% of the surgeries) and those performed in other hospitals, as for the 30-days readmissions rate (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98) and LOS ⩾ 8 days rate (OR: 0.88; 95% CI: 0.87-0.89). These findings were confirmed after risk adjustment and DID analysis. No association was observed with mortality outcomes. On the whole, our study attained mixed results. Although a protective effect of the surgical checklist use could not be proved over the first 5 years of this regional implementation experience, our research offers some methodological insights for practical use in the evaluation process of large-scale implementation projects.

Background Recently, the use of intraoperative magnetic resonance imaging (ioMRI) has evolved in neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potentially hazardous environment. Strict safety guidelines in the operating room (OR) are necessary. Checklists can minimize errors while increasing efficiency and improving workflow. Objective To describe the Zurich checklists for safety in the ioMRI environment. Methods We summarize the checklist protocol and the experience gained from over 300 surgical procedures performed over a 4-yr period using this new system for transcranial or transsphenoidal surgery in a 2-room high-field 3 Tesla ioMRI suite. Results Particularities of the 2-room setting used at our institution can be summarized as (1) patient transfer from a sterile to a nonsterile environment and (2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the strength of the magnetic field, or sterility concerns. Each step in the checklist corresponds to a specific phase and particular actions taken during the workflow in the ioMRI suite. Most steps are relevant to any 2-room ioMRI-OR suite. Conclusion The use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.

Objective To develop and institute a standardized ophthalmology-specific operating room checklist, and to test adherence to the surgical checklist components after implementation. Design An ophthalmology-specific operative room checklist was developed using recommendations from surgical preoperative checklists from other subspecialties and checklists specific to cataract surgery. This standardized checklist was then implemented into the operating rooms. Operative room staff was trained on its use. Adherence to the checklist was measured prospectively. Setting Surgical centers at Kellogg Eye Center in Ann Arbor and Livonia, Michigan. Participants Patients undergoing ophthalmic surgery at the Livonia and Ann Arbor surgical centers. Main Outcome(s) and Measure(s) The primary outcome measures were surgical team adherence to each category of the operative checklist (preop, prebrief, preanesthesia verification, time-out, intraocular lens measurement/confirmation for cataract cases, debrief). Adherence to the subsections of the operative checklist was measured during three periods over the course of 1 year: baseline, postintervention (after introduction of the checklist in all operating rooms), and postadjustment (after additional training was provided to operating room staff and incentives to collect data were provided to personnel responsible for collecting it). Results A total of 2,532 surgical cases were included in the analysis. Baseline adherence ranged from 87 to 90% across preop, prebrief, preanesthesia, and time-out verification sections of the operative checklist. After the institution of the intervention and adjustments, adherence to the surgical checklist improved significantly across all areas of the checklist to 97–98% (p Conclusions and Relevance The development and implementation of an ophthalmology-specific operative room checklist increase adherence to recommended safety checks prior to the start of surgery. To maximize patient safety, the same or similar checklist is recommended for use in all ophthalmology operating rooms.

OBJECT Use of the WHO surgical checklist has been proven to reduce surgical morbidity and mortality, but its effect on surgical complications requiring reoperation has not been previously studied. The aim of this study was to determine whether the use of the WHO surgical checklist would have an impact on the number and causes of neurosurgical complications leading to a reoperation. METHODS The authors retrospectively gathered information on all neurosurgical reoperations using hospital discharge data as well as the operations and procedures registry, and tracked all primary neurosurgical operations (n = 175) preceding a complication-related reoperation from 2007 to 2011. There were a total of 5418 neurosurgical operations during the study period. For further analysis of electronic patient records, the primary operations were divided into 2 groups based on the time of the WHO surgical checklist implementation in the authors' unit: 103 operations before and 72 after the introduction of the checklist. Observed adverse events and reoperations were categorized as preventable or unpreventable, and the actual use of the checklist during each operation was recorded. RESULTS The overall rate of preventable complication-related neurosurgical reoperations decreased from 3.3% (95% CI 2.7%–4.0%) to 2.0% (95% CI 1.5%–2.6%) after the checklist implementation. The reoperations were mainly due to wound infections, 46% before and 39% after the checklist. All infection-related reoperations proportioned to all neurosurgical operations (2.5% before vs 1.6% after checklist implementation) showed a significant reduction (p = 0.02) after the implementation of the checklist. In particular, there was a significant decrease (p = 0.006) in the rate of preventable infections associated with reoperations, i.e., 2.2% before versus 1.2% after checklist implementation. The overall adherence to checklist use (the “time out” phase) in neurosurgical operations was 78%, and adherence was 70% in primary operations preceding a complication-related reoperation regarded as preventable. CONCLUSIONS The implementation of the WHO surgical checklist in neurosurgery was associated with a decrease in complication-related reoperations, especially those due to preventable infection complications, the majority of which were wound infections. The adherence to checklist use in individual operations after the checklist implementation did not appear to have an impact on the results.

Following the Safe Surgery Saves Lives campaign (WHO, 2008), surgical safety checklists (SSCs) were introduced into human operating theatres as a tool to reduce the risk of preventable complications during the perioperative period. The SSC has been largely successful in reducing such incidents in the human field. The use of veterinary SSCs is currently limited, although the benefits of SSCs are likely to be transferable to the veterinary practice. This article discusses the introduction of an SSC into practice and its potential use as a clinical auditing tool.

Summary: Existing evidence suggests that communication failures are common in the operating room, and that they lead to increased complications, including infections. Use of a surgical safety checklist may prevent communication failures and reduce complications. Initial data from the World Health Organization Surgical Safety Checklist (WHO SSC) demonstrated significant reductions in both morbidity and mortality with checklist implementation. A growing body of literature points out that while the physical act of “checking the box” may not necessarily prevent all adverse events, the checklist is a scaffold on which attitudes toward teamwork and communication can be encouraged and improved. Recent evidence reinforces the fact the compliance with the checklist is critical for the effects on patient safety to be realized. Keywords: Surgical checklist, Surgical briefing, Surgical safety, Communication, Compliance

Background Patient safety is a priority for healthcare organizations. For the PRONAP´s 2013 final exam, the Quality & Patient Safety Subcommittee and the PRONAP managers designed a survey to be answered by pediatrician students nationwide. It was destined to evaluate attitudes, practices and safety conditions in which they worked. Aim To assess the current state of practices in patient safety. Material and methods Setting and sample: PRONAP students (7,438 pediatrician nationwide) who answered 2013 final exam. Instrument: Patient Safety Survey about pediatric inpatient (9 domains) and outpatient (5 domains) practices, and population data. Results Patient Safety Survey: 6424 answered (86%). Population: age: 42% 30-40 years. Women: 80%. Residence in Pediatrics: 83%. Patient safety training: 30%. geographical origin: all provinces and CABA. Inpatient practices: 15% answered their institution had Patient Safety Committee. 74% of institutions did not have event reporting systems, 70% didn´t have a patient´s identification system. 32% answered that drug prescription should be done upon vademecum at their institution, and 27% had infection´s control programs, 28% performed surgical checklist in operating room and 55% had a standardized patient hand-off. Outpatient practices: 62% said they had washbasins, 56% had soap available, and 63% alcohol gel. 70% answered children with a supposed infectious rash did not wait his turn separately. Conclusion This study shows that most pediatricians in Argentine work without prioritizing patient safety, both in ambulatory and inpatient practice.

Adherence to surgical safety checklists remains challenging. Our institution demonstrated acceptable rates of checklist utilization but poor adherence to all checkpoints. We hypothesized that stepwise, multifaceted interventions would improve checklist adherence.From 2011 to 2013, adherence to the 14-point, pre-incision checklist was assessed directly by trained observers during three, 1-year periods (baseline, observation #1, and observation #2) during which interventions were implemented. Interventions included safety workshops, customization of a stakeholder-derived checklist, and implementation of a report card system. Chi-square and Kruskal-Wallis tests were utilized.Checklist performance was assessed for 873 cases (baseline, n = 144; observation #1, n = 373; observation #2, n = 356). Total checkpoint adherence increased (from 30% to 78% to 96%; P.001), as did cases with correct completion of all checkpoints (from 0% to 19% to 61%; P.001). The median (interquartile range) number of checkpoints completed per case improved from 4 (3-5) to 11 (10-12) to 14 (13-14; P.001).A strategic, multifaceted approach to perioperative safety significantly improved checklist adherence over 2 years. Checklist content and process need to reflect local interests and operative flow to achieve high adherence rates. Successful checklist implementation requires efforts to change the safety culture, stakeholder buy-in, and sustained efforts over time.

BACKGROUND Recently, the use of intraoperative magnetic resonance imaging (ioMRI) has evolved in neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potentially hazardous environment. Strict safety guidelines in the operating room (OR) are necessary. Checklists can minimize errors while increasing efficiency and improving workflow. OBJECTIVE To describe the Zurich checklists for safety in the ioMRI environment. METHODS We summarize the checklist protocol and the experience gained from over 300 surgical procedures performed over a 4-yr period using this new system for transcranial or transsphenoidal surgery in a 2-room high-field 3 Tesla ioMRI suite. RESULTS Particularities of the 2-room setting used at our institution can be summarized as (1) patient transfer from a sterile to a nonsterile environment and (2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the strength of the magnetic field, or sterility concerns. Each step in the checklist corresponds to a specific phase and particular actions taken during the workflow in the ioMRI suite. Most steps are relevant to any 2-room ioMRI-OR suite. CONCLUSION The use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.

Objectives To identify current attitudes to patient safety among urology trainees. To examine whether these have changed with the recent increase in emphasis on patient safety and the introduction of new working procedures in operating theatres. Subjects and Methods Subjects included 28 urology trainees, based in the West of Scotland, UK. Trainee attitudes were examined using the Operating Room Management Attitudes Questionnaire, a validated tool for examining attitudes towards patient safety. Results Attitudes to teamwork were highly positive, with 89–100% of trainees acknowledging the need to share information and conduct pre- and postoperative briefs, and 82–96% being accepting of multidisciplinary feedback on performance. Attitudes to preoperative briefing and multidisciplinary feedback were improved compared with a similar historical cohort. Trainees were reluctant to acknowledge the effect of stress and fatigue on personal performance; 50% felt they worked effectively in critical phases of operations even when tired, only 50% would tell team members their workload was becoming excessive and only 36% of trainees recognized that personal problems could affect their performance. There was no significant change in these attitudes from 2006 data. Regarding leadership and confidence assertion, 68% of trainees felt that leadership in the operating theatre should rest with the medical staff, 18% stated senior decisions or actions should not be questioned unless they threaten safety and 7% that they should not be questioned at all. This was similar to previous data. Conclusions Attitudes to briefing and multidisciplinary feedback appear to have improved since the introduction of the World Health Organization surgical checklist and wider use of feedback tools; other safety attitudes remain largely unchanged. Urology trainees may benefit from further training to better understand the mechanisms of error development, to raise awareness of human performance limitation, particularly the effects of stress and fatigue, and to develop techniques to challenge decisions/respond to challenges.

Ambulatory surgery centers (ASCs) are being asked to use a safe surgical checklist in 2012 and to report that it has been used in 2013. Checklists should focus on communication and safe surgery practices in each of 3 perioperative periods: (1) before administration of anesthesia, (2) before skin incision, and (3) the period of incision closure and before the patient leaves the operating room. This article reviews the origin of surgical checklists. It examines evidence that indicates that checklists decrease the incidence of human errors, mortality, and morbidity.

The World Health Organisation (WHO) identified patient safety in surgery as an important public health matter and advised the adoption of a universal peri-operative surgical checklist. An adapted version of the WHO checklist has been mandatory in the National Health Service since 2010. Wrong intraocular lens (IOL) implantation is a particular safety concern in ophthalmology. The Royal College of Ophthalmologists launched a bespoke checklist for cataract surgery in 2010 to reduce the likelihood of preventable errors. We sought to ascertain the use of checklists in cataract surgery in 2012. A survey of members of the Royal College of Ophthalmologists seeking views on the use of checklists in cataract surgery. Four hundred and sixty-nine completed responses were received (18% response rate). Respondents worked in England (75%), Scotland (11%), Wales (5%), Northern Ireland (2%), the Republic of Ireland (1%), and overseas (6%). Ninety-four per cent of respondents support the use of a checklist for cataract surgery and 85% say that they always use a checklist before cataract surgery. Sixty-seven per cent of cataract surgeons stated they undertake a pre-operative team brief. Thirty-six per cent use a cataract surgery checklist developed locally, 18% use the college’s bespoke cataract surgery checklist, 39% use a generic surgical checklist, and 4% reported that they do not use a checklist. Ninety-three per cent of cataract surgeons responding to the questionnaire report using a surgical checklist and 67% use a team brief. However, only 54% use a checklist, which addresses the selection of the correct intraocular implant. We recommend wider adoption of checklists, which address risks relevant to cataract surgery, in particular the possibility of selection of an incorrect IOL.

Introduction: The World Health Organization (WHO) Safe Surgery Saves Lives Campaign based on the checklist is aimed at improving surgical safety. The Hospital General de Medellin (HGM) implemented the checklist in June 2009. Objective: To describe the application of WHO’s surgical checklist based on patient-verifiable items and to describe the behavior of adverse events, before and after the implementation of the checklist at the HGM, Colombia. Methods: Cross-sectional study. All major surgery patients of the HGM operated on between

Hintergrund: Die konsequente Anwendung von Sicherheitsbarrieren wie z. B. der chirurgischen OP-Checkliste sind nachweislich effektiv in der Reduktion unerwunschter Ereignisse und verbessern sowohl die Patientensicherheit als auch die Teaminteraktion innerhalb des OP. Dennoch sind viele Arzte noch skeptisch. Nur wer die innere Bereitschaft hat und innerlich von der Notwendigkeit uberzeugt ist, wird Sicherheitssysteme auch tatsachlich verwenden. Daher ist es wichtig, das Thema Patientensicherheit bereits im Medizinstudium zu vermitteln, also bevor Arbeitsablaufe in der taglichen Routine der Ausbildungsassistenten automatisiert werden. Methode: In der vorliegenden Arbeit wird die Einfuhrung des Curriculums „Patientensicherheit“ in das Blockpraktikum an der Chirurgischen Klinik der Universitatsmedizin Greifswald beschrieben. Anschliesend erfolgt eine systematische Analyse der entsprechenden Evaluation von 6 Veranstaltungen eines Studienjahrgangs zwischen April und Oktober 2011. Ergebnisse: Die Auswertung der Evaluation verdeutlicht die hohe Relevanz der Thematik fur die Studenten. Auch die Qualitat des Praktikums, insbesondere in Hinblick auf Effizienz der Wissensvermittlung und Praxisnahe, wird als hoch bewertet. Das didaktische Konzept fand Anerkennung. Kritik bezieht sich in erster Linie auf organisatorische Aspekte, so z. B. auf den Zeitpunkt der Veranstaltung am Nachmittag vor der Blockpraktikumsprufung. Schlussfolgerung: Das Curriculum „Patientensicherheit“ ist geeignet, ein Problembewusstsein zu schaffen, sicherheitsrelevante Aspekte zu verdeutlichen und Handlungsstrategien zu vermitteln. Hierbei erscheint der fruhe Zeitpunkt im klinischen Abschnitt des Medizinstudiums besonders geeignet, da die Studenten in dieser Phase noch unvoreingenommen sind. Wir empfehlen daher die flachendeckende Einfuhrung einer solchen Lehrveranstaltung.

Purpose The purpose of this investigation was to apply an arthroscopic shoulder and knee checklist in the evaluation of orthopedic resident arthroscopic skill efficiency and to demonstrate the use of a surgical checklist for assessing resident surgical efficiency over the course of a surgical rotation. Methods Orthopedic surgery residents rotating on the sports medicine service at our institution between 2011 and 2015 were enrolled in this study. Residents were administered a shoulder and knee arthroscopy assessment tool at the beginning and end of their 6-week rotation. The assessment tools consisted of checklist items for knee and shoulder arthroscopy skills. Residents were timed while performing these checklist tasks. The primary outcome measure was resident improvement as a function of time to completion for the checklist items, and the intervention was participation in a 6-week resident rotation with weekly arthroscopy didactics, cadaver simulator work, and operating room experience. A paired t test was used to compare means. Results Mean time to checklist completion during week 1 among study participants for the knee checklist was 787.4 seconds for the knee checklist and 484.4 seconds at the end of the rotation. Mean time to checklist completion during week 1 among study participants for the shoulder checklist was 1655.3 seconds and 832.7 seconds for the shoulder checklist at the end of the rotation. Mean improvement in time to completion was 303 seconds (p = 0.0006, SD = 209 s) and 822.6 seconds (p = 0.00008, SD = 525.2 s) for the arthroscopic knee and shoulder assessments, respectively. Conclusions An arthroscopic checklist is 1 method to evaluate and assess resident efficiency and improvement during surgical training. Among residents participating in this study, we found statistically significant improvements in time for arthroscopic task completion. Level of Evidence II

El objetivo del presente estudio es describir y comparar los porcentajes de no cumplimentación de dos instrumentos de registro: hoja circulante (HC) y lista de verificación quirúrgica (LVQ), en un mismo entorno quirúrgico para una muestra de pacientes de características similares. Metodología: Estudio descriptivo realizado sobre registros intraquirúrgicos de 3024 pacientes de Cirugía de Ortopedia y Traumatología. 1732 pacientes intervenidos en 2009 con modelo de hoja circulante, cumplimentada al finalizar la intervención y 1292 en 2010 intervenidos con modelo de registro lista de verificación quirúrgica (checklist) cumplimentado durante la intervención en tres tiempos. Se han calculado características descriptivas (media, desviación típica, mínimo y máximo) del porcentaje de no cumplimentación global en ambos registros y el porcentaje de no cumplimentación (intervalo de confianza al 95%) de cada ítem de los registros estudiados. Resultados: Se observa mayor porcentaje de cumplimentación global y, en general, también individual, en la hoja circulante que en la lista de verificación quirúrgica. Enfermería Global Nº 41 Enero 2016 Página 184 Conclusiones: El registro intraquirúrgico que mayor porcentaje de cumplimentación ha tenido de manera global ha sido la hoja de circulante y se evidencia la necesidad de implantar estrategias para mejorar el grado de cumplimentación de la LVQ por su relación con la seguridad de pacientes. ABSTRACT The objective of this study is to describe and compare the percentages of non-filling-in two recording instruments: Current sheet and surgical checklist in the same surgical setting for a sample of patients with similar characteristics. Methods: Descriptive study carried out with the intraoperative records of 3024 patients from Orthopedic Surgery and 1732 patients who were operated in 2009 with current sheet model completed at the end of the surgery and 1292 patients in 2010 with surgical checklist as recording model, completed during the intervention in three stages. Descriptive characteristics (mean, standard deviation, minimum and maximum) were calculated from the overall percentage of non-completion in both records, as well as the non-filling-in percentage (and confidence interval at 95%) of each item of the records studied. Results: A higher overall – and also individual, in general- percentage of filling-in is observed in the current sheet than in the surgical checklist. Conclusions: In general terms, the intraoperative recording with the highest percentage of being filledin has been the circulating sheet and it has been observed the necessity to implement strategies to improve the level of filling-in due to its relationship with surgical clinical safety.

Objective: Despite the known positive impact of surgical checklists on morbidity and mortality rates, data on the implementation of checklists in Swiss operating rooms as well as the resulting experiences are missing. The present study evaluated the general use and design of checklists in operative medicine in Switzerland, the difficulties in introduction and the subjective impact on adverse events. Methods: An anonymous national survey of directors of adult departments in operative medicine in Switzerland was conducted during spring 2011. They were identified from the database of the Swiss college of surgeons (fmCh). The survey included questions about the use, type and content of the used checklists, the prevention of mixing up patients and the awareness of wrong site surgery. Results: Overall, 237/799 (29.7%) surveys were returned. At the time of the survey, 172/233 (73.8%) departments used surgical checklists (4 missing values). The median time needed for collecting data per patient was 60 (range 10-600) seconds. In all, 46/161 (28.6%) participants reported a subjective decrease of adverse events after the introduction of a surgical checklist (11 missing values). Out of 217 respondents, 62 (28.6%) knew of one event and 87 (40.1%) of more than one event of wrong site surgery (20 missing values). Conclusions: There is still room for improvement in the use of surgical checklists, which impresses, in regard to the time needed for data collection per patient, and which is not excessively time-consuming. However, acceptance problems of the majority of respondents during the introduction phase of surgical checklists vanished over time. [Arch Clin Exp Surg 2012; 1(3.000): 158-167]

The Safety Checklist concept has been an integral part of many industries that face high-complexity tasks for many decades and in industries such as aviation and engineering checklists have evolved from their very inception. Investigations of the causes of surgical deaths around the world have repeatedly pointed to medical errors that could be prevented as an important cause of death and disability. As a result, the World Health Organisation developed and evaluated a three-stage surgical checklist in 2007 demonstrating that complications were significantly reduced, including surgical infection rates and even mortality. Together with the results from other large cohort studies into the utility of the surgical checklist, many countries have fully implemented the use of surgical checklists into routine practice. A key factor in the successful implementation of a surgical checklist is engagement of the staff implementing the checklist. In surgical specialties such as our own it was quickly seen that there were many important omissions in the generic checklist that did not cover issues particular to our specialty, and thus the European Association for Cardio-Thoracic Surgery embarked on a process to create a version of the checklist that might be more appropriate and specific to cardiothoracic surgery, including checks on preparations for excessive bleeding, perfusion arrangements and ICU preparations, for example. The guideline presented here summarizes the evidence for the surgical checklist and also goes through in detail the changes recommended for our specialty.

Resumo Objetivo Construir e validar checklist cirúrgico para segurança do paciente e prevenção de infecção de sítio cirúrgico. Métodos Pesquisa quantitativa realizada para validar instrumento criado e utilizado em cirurgia segura. O instrumento foi validado por sete peritos. Para concordância entre os juízes utilizou-se o coeficiente de concordância de Kendall e para verificar se a opinião dos juízes diferiu significativamente, o teste de Cochran. O instrumento é validado se houver concordância entre os juízes e a clareza for significante. Resultados Na primeira avaliação do instrumento, obteve-se Kendall de 0,230 para pertinência e 0,390 para clareza, o que implicou em reformulação do checklist. Após a reformulação, obteve-se concordância absoluta para pertinência e não houve diferença significativa para clareza. Com o instrumento validado, foi criado um sistema informatizado para inserção dos dados coletados. Conclusão O instrumento criado foi validado e pode auxiliar na segurança do paciente e prevenção de infecção de sítio cirúrgico. Abstract Objective To design and validate a surgical checklist to improve patient safety and prevent surgical site infection. Methods This quantitative study was carried out to validate an instrument created and used for surgical safety. Seven experts validated the instrument. For agreement among experts, was used Kendall’s concordance coefficient; if their opinions differed significantly, the Cochran’s test was adopted. An instrument is validated when concordance among experts is achieved and its clarity is significant. Results In the first assessment of the instrument, Kendall’s concordance coefficients were 0.230 in terms of pertinence and 0.390 for clarity. These results cauded a reformulation in the checklist. After reformulation, an absolute concordance was achieved for pertinence and no significant difference was seen in terms of clarity. After instrument validation, was created an information system to input data collected. Conclusion The instrument was validated. It can help improve patient safety and prevent surgical site infection.