title: Meaningful use and good catches: More appropriate metrics for checklist effectiveness.
abstract: The benefit of utilizing surgical safety checklists has been recently questioned. We evaluated our checklist performance after implementing a program that includes checklist-related good catches.
  
  
  
  Multifaceted interventions aimed at the preincision checklist and 5 prospective audits were conducted from 2011-2015. We documented adherence to the checklist (verbalization of each checkpoint), fidelity (meaningful performance of each checkpoint), and good catches (events with the potential to cause the patient harm but that were prevented from occurring). Good catches were divided into quality improvement-based categories (processes, medication, safety, communication, and equipment).
  
  
  
  A total of 1,346 checklist performances were observed (range, 144-373/yr). Adherence to the preincision checklist improved from 30% to 95% (P < .001), while adherence to the preinduction and debriefing checklists decreased (71% to 56%, P = .002) and remained unchanged (76%), respectively. Preincision fidelity decreased from 86% to 76% (P = .012). Good catches were identified during 16% of preincision checklist performances; process issues were most common (32%) followed by issues of medication administration (30%) and safety (22%).
  
  
  
  Implementation of a systematic checklist program resulted in significant and sustainable improvement in performance. Meaningful use and associated good catches may be more appropriate metric than actual patient harm for measuring checklist effectiveness. Although not previously described, checklist-related good catches represent an unknown benefit of checklists.
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Kathryn T
authors.initials: KT
authors.lastname: Anderson
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Diffley
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Aubrey A
authors.initials: AA
authors.lastname: Hildebrandt
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Caldwell
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Minzenmayer
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Covey
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Akemi L
authors.initials: AL
authors.lastname: Kawaguchi
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX. Electronic address: Kuojen.Tsao@uth.tmc.edu.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
mesh_terms: D057189:Checklist; D002648:Child; D015331:Cohort Studies; D019983:Guideline Adherence; D006801:Humans; D062527:Meaningful Use; D019300:Medical Errors / Q000517:prevention & control*; D064406:Patient Harm / Q000517:prevention & control*; D061214:Patient Safety; D015397:Program Evaluation; D058996:Quality Improvement