Surgical safety checklist: implementation in an ambulatory surgical facility

Area of Science:

• Surgical Safety Protocols
• Ambulatory Surgery
• Patient Outcomes

Background:

• The World Health Organization (WHO) developed the Surgical Safety Checklist (SSC) in 2007 to standardize surgical safety.
• Ambulatory surgical facilities require tailored safety measures beyond general surgical standards.

Purpose of the Study:

• To adapt the WHO SSC with ambulatory-specific items.
• To implement these additions in an ambulatory surgical setting.
• To evaluate the impact on patient outcomes, including postoperative pain and nausea/vomiting.

Main Methods:

• A Safety Attitudes Questionnaire was administered to staff.
• Seven ambulatory-specific items were added to the SSC.
• Data were collected from 180 pre-implementation and 195 post-implementation surgical cases.
• Compliance with checklist sections and specific items was assessed.

Main Results:

• No significant improvement was observed in postoperative pain or post-discharge nausea/vomiting rates.
• Safety attitudes and most secondary outcomes did not improve, except for preemptive pain medication use.
• High compliance was noted for standard SSC sections (briefing, time out, debriefing), but low compliance for verbalizing new ambulatory-specific items.

Conclusions:

• Challenges in user buy-in, checklist length, and prioritization hindered the integration of ambulatory-specific items.
• A revised, shortened SSC was developed based on study findings.
• Further research may be needed to optimize safety checklists for ambulatory settings.