title: Does a novel method of delivering the safe surgical checklist improve compliance? A closed loop audit.
abstract: BACKGROUND
  In February 2010, the UK National Patient Safety Agency set a mandate that the World Health Organisation's Surgical Safety Checklist (SSC) should be completed for every surgical patient within the NHS in a bid to improve surgical safety. However since its introduction, there have been issues with checklist compliance, staff engagement and surgical serious incidents continue.
  
  
  OBJECTIVE
  This study seeks to explore if an unavoidable pre-recorded audio delivery of the SSC improves compliance and staff engagement with the checklist.
  
  
  METHODS
  The performance of the time-out and sign-out sections of the SSC were observed in three phases: standard practice, audio prompt and full audio delivery. Two researchers visited operating theatres throughout a three-week period. The outcome measures were occurrence of time-out/sign-out, completion of checklist, and presence, and engagement of staff during checklist administration. Staff feedback on the process was also sought.
  
  
  RESULTS
  Observation of time-out and sign-out was undertaken for 92 procedures. Time-out and sign-out were performed for 100% of the procedures when using full audio delivery of the SSC, an improvement on findings during the standard practice phase (time out- 97.4%, sign out- 86.8%). The compliance with completion of checklist items also improved with audio delivery of the SSC. However, the presence of all key staff and active participation of team members with the checklist was unaffected by the mode of delivery. Team members' self-reported engagement did not significantly vary across the different practices.
  
  
  CONCLUSIONS
  The intervention seems to improve rate of checklist completion, particularly signout. It also brought more consistency on the questions read out during checklist administration. It doesn't necessarily ensure all key staff are present neither does it significantly improve staff engagement in the process.
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Reed
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Rutendo
authors.initials: R
authors.lastname: Ganyani
authors.affiliation: University Hospitals Coventry & Warwickshire NHS Trust, Warwick University, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: King
authors.affiliation: University Hospitals Coventry & Warwickshire NHS Trust, Institute of Digital Health, Warwick University, UK. Electronic address: meghana.pandit@uhcw.nhs.uk.
authors.forename: Meghana
authors.initials: M
authors.lastname: Pandit
mesh_terms: D057189:Checklist / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D009873:Operating Rooms / Q000592:standards; D061214:Patient Safety / Q000592:standards; D017064:Process Assessment, Health Care; D013222:State Medicine; D013514:Surgical Procedures, Operative / Q000592:standards*; D006113:United Kingdom
keywords: Checklists; Compliance; Safety culture