title: Surgical safety checklist: implementation in an ambulatory surgical facility.
abstract: OBJECTIVE
  In 2007, the World Health Organization created a Surgical Safety Checklist (SSC) that encompassed a simple set of surgical safety standards. The threefold purpose of this study was to add ambulatory-specific items to the SSC, to introduce the items into an ambulatory surgical facility, and to determine if patient outcomes regarding postoperative pain and nausea/vomiting improved following implementation. In addition, safety attitudes, antibiotic timing, regional anesthesia/nerve blocks, preemptive pain medications, prophylactic antiemetics, length of stay, and hospital admission were also assessed.
  
  
  METHODS
  After Research Ethics Board approval, staff complete a Safety Attitudes Questionnaire. Seven items were added to the SSC. Data were then collected on 180 surgical cases before SSC implementation and 195 cases following implementation. Compliance with each section of the SSC was assessed.
  
  
  RESULTS
  On postoperative day one, the median (97.5% confidence interval [CI]) difference between pre- and post-implementation pain scores was 0.5 (97.5% CI, 0 to 1; P = 0.13), and the median difference in the rate of post-discharge nausea/vomiting was -8.4% (97.5% CI, -17.9 to 1.1; P = 0.06). There was no improvement in safety attitudes or any of the secondary outcomes, with the exception of the use of preemptive pain medications. Compliance with the three sections of the checklist, i.e., briefing, time out, and debriefing was 99.49%, 97.95%, and 96.92%, respectively. There was low compliance in verbalization of the added "ambulatory-specific items".
  
  
  CONCLUSIONS
  Potential reasons for lack of uptake and integration include poor "user" buy-in, an overly lengthy checklist, and lack of prioritization of ambulatory-specific items. A shortened SSC was developed based on the results of this study. This trial was registered at ClinicalTrials.gov ID: NCT00934310.
authors.affiliation: Department of Anesthesia, Women's College Hospital, University of Toronto, 76 Grenville St, Toronto, ON M5S 1B2, Canada. pam.morgan@utoronto.ca
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Morgan
authors.forename: Lisa
authors.initials: L
authors.lastname: Cunningham
authors.forename: Sohini
authors.initials: S
authors.lastname: Mitra
authors.forename: Natalie
authors.initials: N
authors.lastname: Wong
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.forename: Victoria
authors.initials: V
authors.lastname: Noguera
authors.forename: Mary
authors.initials: M
authors.lastname: Li
authors.forename: John
authors.initials: J
authors.lastname: Semple
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D057189:Checklist; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000592:standards; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D061214:Patient Safety; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D011795:Surveys and Questionnaires