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World Health Organization Surgical Safety Checklist Modification: Do Changes Emphasize Communication and Teamwork?
Ian Solsky1, William Berry2, Lizabeth Edmondson1
1Ariadne Labs, Boston, Massachusetts.
The Journal of Surgical Research
|December 12, 2018
Summary
Surgical safety checklists are extensively modified, often with added items that may not enhance teamwork. Critically, elements from the World Health Organization's "Anticipated Critical Events" section are frequently removed.
Area of Science:
- Healthcare Quality and Safety
- Surgical Patient Care
- Health Services Research
Background:
- The World Health Organization (WHO) surgical safety checklist aims for customization to improve local implementation, team engagement, and safety culture.
- Global adoption of the WHO checklist is widespread, yet the extent and nature of its modifications remain understudied.
Purpose of the Study:
- To investigate the degree and types of modifications made to the World Health Organization (WHO) surgical safety checklist in nonsubspecialty settings.
- To analyze how checklist content and formatting are altered from the original WHO standard.
Main Methods:
- Nonsubspecialty surgical checklists were collected via online searches and hospital requests.
- A detailed coding scheme was developed to systematically analyze checklist modifications.
- Descriptive statistics were employed to summarize the findings.
Main Results:
- All 155 analyzed checklists showed modifications, with most being longer and containing more items than the WHO original.
- Frequently added items included those related to implants, deep vein thrombosis prophylaxis, and patient positioning.
- A significant number of checklists removed WHO items, notably the pulse oximeter check and critical elements from the 'Anticipated Critical Events' section.
Conclusions:
- Surgical safety checklists are highly customized, but modifications may not always promote discussion or teamwork.
- The frequent removal of items from the WHO's 'Anticipated Critical Events' section is a notable concern for patient safety communication.
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