title: A 'paperless' wall-mounted surgical safety checklist with migrated leadership can improve compliance and team engagement.
abstract: Outcome benefits of using the WHO Surgical Safety Checklist rely on compliance with checklist administration.
  
  
  
  To evaluate engagement of operating room (OR) subteams (anaesthesia, surgery and nursing), and compliance with administering checklist domains (Sign In, Time Out and Sign Out) and checklist items, after introducing a wall-mounted paperless checklist with migration of process leadership (Sign In, Time Out and Sign Out led by anaesthesia, surgery and nursing, respectively).
  
  
  
  This was a pre-post observational study in which 261 checklist domains in 111 operations were observed 2 months after changing the checklist administration paradigm. Compliance with administration of the checklist domains and individual checklist items was recorded, as was the number of OR subteams engaged. Comparison was made with 2013 data from the same OR suite prior to the paradigm change.
  
  
  
  Data are presented as 2013 versus the present study. The Sign In, Time Out and Sign Out domains were administered in 96% vs 98% (p=0.69), 99% vs 99% (p=1.00) and 22% vs 84% (p<0.001) of cases, respectively. The percentage of relevant checklist items administered in each domain was 60% vs 92%, 84 vs 93% and 80% vs 99%, respectively (p<0.001 for all comparisons). Two-subteam (or better) engagement at Sign In (surgeons usually absent) was 40% vs 94% of cases. Three-subteam (or all staff present) engagement at Time Out and Sign Out was 15% vs 92% and 9% vs 25% of cases, respectively (p<0.001 for all comparisons).
  
  
  
  Improvements in team engagement and compliance with administering checklist items followed introduction of migrated leadership of checklist administration and a wall-mounted checklist. This paradigm change was relatively simple and inexpensive.
authors.affiliation: Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.
authors.forename: Aaron Pin Chien
authors.initials: AP
authors.lastname: Ong
authors.affiliation: Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Devcich
authors.affiliation: Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hannam
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Tracey
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.|Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
authors.affiliation: Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand.|Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Mitchell
mesh_terms: D057189:Checklist; D019983:Guideline Adherence; D006801:Humans; D007857:Leadership; D009873:Operating Rooms / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D057175:Posters as Topic; D017410:Practice Guidelines as Topic
keywords: Checklists; Compliance; Leadership; Patient safety; Safety culture