Use of Technology to Improve the Adherence to Surgical Safety Checklists in the Operating Room

Although checklists can improve safety in the operating room (OR), compliance with their use is variable. Use of a forcing function, a principle of human factors engineering, has not been reported earlier as a method of increasing checklist use. The authors conducted this study to determine the feasibility and effects of introducing a forcing function on OR surgical safety checklist implementation and adherence.

The authors developed and introduced the use of an electronic version of the surgical safety checklist on an Android application, provided on a personal device available in the OR. This application was linked by Bluetooth to electrocautery equipment, which could not be started before the electronic checklist was completed on the screen of the personal device. In the same OR, retrospective data from use of the traditional (paper-based) checklist were compared with data from the new electronic checklist for frequency of use, and completeness (percentage of all checklist items completed) at three stages of the surgical process-sign-in, time-out, and sign-out.

The frequency of use was 100.0% for the electronic checklist, compared with 97.9% for the traditional checklist. The frequency of completeness was 27.1% for the traditional vs. 100.0% for the electronic (p < 0.001).The manual checklist's sign-out component was completed only 37.0% of the time.

Although checklist use in some form was already high with the traditional checklist, completion rate was low and significantly increased with the use of the electronic checklist with a forcing function.