title: Compliance and quality in administration of a Surgical Safety Checklist in a tertiary New Zealand hospital.
abstract: OBJECTIVE
  Recent studies have demonstrated a reduction in perioperative complications if a surgical safety checklist is utilised. In our institution an adaptation of the WHO Surgical Safety Checklist is administered in 3 "domains": on arrival of the patient in the operating room (Sign In); before surgical incision (Time Out) and before the patients leaves the operating room (Sign Out). Since incomplete administration or staff disengagement could diminish any safety benefit we evaluated administration of this checklist.
  
  
  METHODS
  100 adult surgical cases were observed. Compliance with administration of the Sign In, Time Out, and Sign Out domains and their component checklist items was recorded. The timing of the checklist administration, and engagement of operating room teams were also assessed.
  
  
  RESULTS
  The rate (per 100 cases) of the checklist domain administration was: 99 for Sign In; 94 for Time Out; and 2 for Sign Out. The mean (range) checklist item compliance was 56% (27-100%) for Sign In, 69% (33-100%) for Time Out, and 40% for Sign Out. Checklist items related to patient identity and surgical procedure were administered in 100% of Sign In administrations. Timing of the checklist administration was appropriate in over 80% of cases. Engagement by theatre teams was frequently incomplete.
  
  
  CONCLUSIONS
  The Sign Out domain was almost always omitted, which may increase the risk of important omissions in postoperative care. Most other aspects of checklist administration could also be improved. This will require strong leadership from senior clinicians in all relevant teams.
authors.affiliation: University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vogts
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Hannam
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D057189:Checklist; D002983:Clinical Competence; D003953:Diagnosis-Related Groups; D006801:Humans; D009520:New Zealand; D010348:Patient Care Team / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D017751:Safety Management / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000592:standards*; D014944:World Health Organization