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Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a
Janaka Lagoo1, Steven R Lopushinsky2, Alex B Haynes1,3
1Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
Paediatric surgical safety checklists (SSCs) show potential when implemented with comprehensive strategies, especially in low-resource settings. Parental involvement may enhance patient safety and checklist acceptance.
Area of Science:
- Patient Safety
- Surgical Quality Improvement
- Health Systems Research
Background:
- The World Health Organization Surgical Safety Checklist (SSC) is globally adopted.
- Limited data exists on SSC integration in pediatric surgery.
Purpose of the Study:
- To systematically review the effectiveness and meaningful use of pediatric surgical safety checklists (SSCs).
- To evaluate various SSC implementation strategies in pediatric surgical settings.
Main Methods:
- Systematic review with narrative synthesis of 20 high-quality studies.
- Searches across major databases including PubMed, Embase, and Cochrane.
- Data extraction and thematic analysis using subgroup analyses and idea webbing.
Main Results:
- SSC introduction without implementation strategies did not impact clinical outcomes.
- Comprehensive strategies in developing countries improved outcomes in high-risk surgeries.
- Meaningful compliance was inconsistently measured; feedback and team education enhanced acceptance and compliance.
Conclusions:
- SSC implementation strategies tailored for pediatric patients and families achieve high acceptability and compliance.
- The role of SSCs in improving pediatric surgical outcomes is not well-established but shows promise with comprehensive strategies, particularly for high-risk patients in low-resource settings.
Objective:
To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.
Summary Background Data:
Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.
Methods:
A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.
Results:
1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.
Conclusions:
A SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs' role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.
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