title: Use of surgical safety checklists in Australian operating theatres: an observational study.
abstract: BACKGROUND
  The use of surgical safety checklists (SSC) is an intervention aimed at reducing mortality and morbidity. Although the effectiveness of their use in surgery has been studied extensively, little is known about their practical use in Australian hospitals. The aim of this study was to observe and document the use of SSC in Australia.
  
  
  METHODS
  This study employed direct observations of checklist use for surgical procedures by trained observers. Medical records were also audited to determine compliance with checklist use and to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records).
  
  
  RESULTS
  Among the 11 participating hospitals, overall observed mean completion of the components of the checklist was 27%. Only one hospital used the original World Health Organization checklist. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were: correct patient (99%) and procedure (97%), whether the patient had any allergies (80%), and whether the instrument counts were performed correctly (56%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (86% completion) in comparison to the 27% observed.
  
  
  CONCLUSIONS
  This is the first study of surgical checklist use within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records.
authors.affiliation: The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Giles
authors.affiliation: The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Zachary
authors.identifier: http://orcid.org/0000-0002-7091-5842
authors.initials: Z
authors.lastname: Munn
authors.affiliation: The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Aromataris
authors.affiliation: Australian Patient Safety Foundation, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Anita
authors.initials: A
authors.lastname: Deakin
authors.affiliation: Australian Patient Safety Foundation, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Schultz
authors.affiliation: Radiology Events Register, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mandel
authors.affiliation: The Queen Elizabeth Hospital, SA Health, Adelaide, South Australia, Australia.|School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Guy
authors.initials: G
authors.lastname: Maddern
authors.affiliation: The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Pearson
authors.affiliation: Australian Patient Safety Foundation, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Runciman
mesh_terms: D001315:Australia / Q000453:epidemiology; D057189:Checklist / Q000941:ethics / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit / Q000379:methods; D009873:Operating Rooms / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*; D014944:World Health Organization
keywords: Australia; audit; checklist; patient safety; surgical procedures