"Some version, most of the time": The surgical safety checklist, patient safety, and the everyday experience of practice variation

Melanie Hammond Mobilio; Elise Paradis; Carol-Anne Moulton

doi:10.1016/j.amjsurg.2021.11.002

"Some version, most of the time": The surgical safety checklist, patient safety, and the everyday experience of practice variation

Am J Surg. 2022 Jun;223(6):1105-1111. doi: 10.1016/j.amjsurg.2021.11.002. Epub 2021 Nov 17.

Authors

Melanie Hammond Mobilio¹, Elise Paradis², Carol-Anne Moulton³

Affiliations

¹ The Wilson Centre, University Health Network, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada.
² Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.
³ The Wilson Centre, University Health Network, Canada; Department of Surgery, University of Toronto, Canada. Electronic address: Carol-anne.moulton@uhn.ca.

PMID: 34809907
DOI: 10.1016/j.amjsurg.2021.11.002

Abstract

Background: This study investigated checklist compliance to highlight where assumptions about the Surgical Safety Checklist might not be met in practice.

Methods: We used ethnographic methods to investigate the practice of the Surgical Safety Checklist in one hospital. Fifty-one observation days, eight semi-structured interviews, and two surveys of operating room staff over two years were conducted. Data were collected and analyzed iteratively.

Results: Despite the near 100% compliance rates reported to the Ministry of Health, practice of the Surgical Safety Checklist varied widely: 82% of Briefings, 76% of Time-Outs, and 22% of Debriefings included some sort of team huddle. Gaps between policy and practice were identified at four different levels: compliance with the stages and items; responsibility for the checklist; documentation of adherence; and interprofessional teamwork.

Conclusions: Checklist compliance data are insufficient to understand how complex interventions impact care delivery. Greater and continued attention to practice in healthcare is needed.

Keywords: Patient safety; Qualitative research; Surgery; Surgical safety checklist.

MeSH terms

Checklist*
Documentation
Hospitals
Humans
Operating Rooms
Patient Care Team
Patient Safety*