title: Suboptimal compliance with surgical safety checklists in Colorado: A prospective observational study reveals differences between surgical specialties.
abstract: BACKGROUND
  Surgical safety checklists (SSCs) are designed to improve team communication and consistency in care, ultimately avoiding complications. In Colorado, hospitals reported that use of SSCs was standard practice, but a statewide survey indicated that SSC use was inconsistent. The purpose of this project was to directly observe the compliance with the SSC in Colorado hospitals, through direct observation of the perioperative checklist process.
  
  
  METHODS
  Ten hospitals participated in a quality improvement initiative. Trained team members recorded compliance with each of the components of the SSC. Data analysis was performed using a chi-squared test or ANOVA, depending on the number of categorical variables, with p < 0.05 determining statistical significance.
  
  
  RESULTS
  Ten hospitals representing statewide diversity submitted 854 observations (median 98, range 24-106). 83% of cases were elective, 13% urgent, and 4% emergent/trauma. There was significant variation across hospitals in: team introductions, cessation of activity, affirming correct procedure, assessing hypothermia risk, need for beta blocker, or VTE prophylaxis. Uniformly poor compliance was observed with respect to assessment of case duration, blood loss, anesthesiologists' concerns, or display of essential imaging. Only 71% of observers reported active participation by physicians; 9% reported that "the majority did not pay attention" and 4% reported that the team was "just going through the motions". There were significant differences among surgical specialty groups in the majority of the elements.
  
  
  CONCLUSIONS
  SSCs have been implemented by the vast majority of hospitals in our state; however, compliance with SSC completion in the operating room has wide variation and is generally suboptimal. Although this study was not designed to correlate SSC compliance with outcomes, there are concerns about the risk of a sentinel event or unanticipated complication resulting from poor preparation.
authors: Department of Surgery, Denver Health Medical Center, 777 Bannock St., MC 0206, Denver, CO 80204 USA.
authors: Walter L
authors: WL
authors: Biffl
authors: Department of Surgery, Denver Health Medical Center, 777 Bannock St., MC 0206, Denver, CO 80204 USA.
authors: Annalee W
authors: AW
authors: Gallagher
authors: Department of Surgery, Denver Health Medical Center, 777 Bannock St., MC 0206, Denver, CO 80204 USA.
authors: Fredric M
authors: FM
authors: Pieracci
authors: Department of Surgery, Denver Health Medical Center, 777 Bannock St., MC 0206, Denver, CO 80204 USA.
authors: Crystal
authors: C
authors: Berumen
keywords: Checklist; Compliance; Implementation; Observation; Operating room; Safety; Sentinel events; Surgeons; Surgery
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