Increasing compliance with the World Health Organization Surgical Safety Checklist-A regional health system's experience.
BACKGROUND
In 2009, NorthShore University HealthSystem adapted the World Health Organization Surgical Safety Checklist (SSC) at each of its 4 hospitals. Despite evidence that SSC reduces intraoperative mistakes and increase patient safety, compliance was found to be low with the paper form. In November 2013, NorthShore integrated the SSC into the electronic health record (EHR). The aim was to increase communication between operating room (OR) personnel and to encourage best practices during the natural workflow of surgeons, anesthesiologists, and nurses. The purpose of this study was to examine the impact of an electronic SSC on compliance and patient safety.


METHODS
An anonymous OR observer selected cases at random and evaluated the compliance rate before the rollout of the electronic SSC. In June 2014, an electronic audit was performed to assess the compliance rate. Random OR observations were also performed throughout the summer in 2014. Perioperative risk events, such as consent issues, incorrect counts, wrong site, and wrong procedure were compared before and after the electronic SSC rollout. A perception survey was also administered to NorthShore OR personnel.


RESULTS
Compliance increased from 48% (n = 167) to 92% (n = 1,037; P < .001) after the SSC was integrated into the electronic health record. Surgeons (91% vs 97%; P < .001), anesthesiologists (89% vs 100%; P < .001), and nurses (55% vs 93%; P < .001) demonstrated an increase in compliance. A comparison between risk events in the pre- and post-rollout period showed a 32% decrease (P < .01). Hospital-wide indicators including length of stay and 30-day readmissions were lower. In a survey to assess the OR personnel's perceptions of the new checklist, 76% of surgeons, 86% of anesthesiologists, and 88% of nurses believed the electronic SSC will have a positive impact on patient safety.


CONCLUSIONS
The World Health Organization SSC is a validated tool to increase patient safety and reduce intraoperative complications. The electronic SSC has demonstrated an increased compliance rate, a reduced number of risk events, and most OR personnel believe it will have a positive impact on patient safety.
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Matthew E
ME
Gitelis
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Adelaide
A
Kaczynski
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Torin
T
Shear
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Mark
M
Deshur
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Mohammad
M
Beig
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Meredith
M
Sefa
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Jonathan
J
Silverstein
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. Electronic address: mujiki@northshore.org.
Michael
M
Ujiki
D001291:Attitude of Health Personnel; D057189:Checklist / Q000592:standards*; D054869:Clinical Audit; D015331:Cohort Studies; D057286:Electronic Health Records; D006801:Humans; D007087:Illinois; D007431:Intraoperative Complications / Q000517:prevention & control*; D007902:Length of Stay / Q000706:statistics & numerical data; D019300:Medical Errors / Q000517:prevention & control*; D010359:Patient Readmission / Q000706:statistics & numerical data; D061214:Patient Safety / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D012041:Regional Medical Programs; D012189:Retrospective Studies; D017751:Safety Management / Q000379:methods*; D014944:World Health Organization
Compliance; Surgical Safety Checklist; World Health Organization