Decreasing intraoperative delays with meaningful use of the surgical safety checklist.

BACKGROUND: Purposeful completion (fidelity) more than simple adherence to items in the surgical safety checklist may improve operating room efficiency and patient safety. The purpose of this study was to evaluate intraoperative delays and correlate them with adherence and fidelity to the preincision surgical safety checklist. METHODS: Trained observers evaluated surgical safety checklist compliance during 3 observation periods from 2014-2016. Degree of adherence, checkpoint verbalization, fidelity, and meaningful completion were assessed. Delays were categorized as missing or malfunctioning equipment, staff error, and medication issues. Descriptive statistics, analysis of variance, logistic regression, χ2 and Student t test were used to analyze results. RESULTS: Of the 591 cases observed, 19% (n = 110) had at least one documented, intraoperative delay. The majority of delays were related to missing (50%) or malfunctioning (30%) equipment. Compared with cases without delays, cases with delays did not have a different mean degree of adherence (96.3 ± 7.6% vs 95.6 ± 5.8%, P = .36). Degree of fidelity was different between cases with and without delays (mean fidelity 77.1 ± 14.9% vs 80.5 ± 7.14.2%, P = .03). CONCLUSION: The preincision SSC is a communication tool offering an opportunity to discuss potential concerns and anticipated intraoperative needs. Fidelity rather than adherence to the surgical safety checklist seems to diminish intraoperative delays.

Debriefing: the forgotten phase of the surgical safety checklist.

BACKGROUND: The debriefing phase of the surgical safety checklist (SSC) provides the operative team an opportunity to share pertinent intraoperative information and communicate postoperative plans. Prior quality improvement initiatives at our institution focused on the preincision phase of the SSC; however, the debriefing phase has not been evaluated. We aimed to assess adherence to the debrief checklist at our institution and identify areas for improvement. MATERIALS AND METHODS: An observational study was conducted from 2014 to 2016 with a convenience sample of pediatric surgery cases at an academic children's hospital over 8-wk periods annually to evaluate the debriefing checklist across 14 subspecialties. Intraoperative team members' adherence to eight prespecified checkpoints was assessed. Descriptive statistics, Pearson's chi square, Kruskal-Wallis rank test, and Cohen's kappa for interrater reliability were used (P < 0.05 was significant). RESULTS: A total of 603 cases were observed (2014 n = 191; 2015 n = 195; 2016 n = 217). The debriefing checklist was conducted in 90.6%, 90.3%, and 94.9% of observed cases each year respectively with the median number of checklist items completed relatively unchanged (8, 7, and 7, range 0-8). However, the checklist was only fully completed in 55%, 48%, and 50% of cases over the study period (P = 0.001) with no debriefing at all in approximately 9% of cases in 2014 and 2015 versus 5% in 2016 (P < 0.001). Interrater reliability annually was >0.65. CONCLUSIONS: Despite slight increases annually in overall compliance to the debriefing checklist, only half of all checklists were completed in full. Future efforts to augment adherence are needed and will include interventions targeting the debriefing phase and increasing operating room efficiency.