3 Tips to Implement a Surgical Safety Checklist

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In 2010, Saint Francis Hospital and Medical Center in Hartford, Conn., implemented the World Health Organization's Surgical Safety Checklist to reduce infection rates in the operating room. While a checklist is a simple tool, successfully using the checklist was harder than simply handing out checklists to team members.

"It became very clear early on that the checklist is only as good as the people who are trained to use it," says Scott J. Ellner, DO, MPH, vice chairman of surgery and director of surgical quality at the hospital. He provides three tips for implementing a surgical safety checklist.

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1. Empower team members. The people who will use the surgical safety checklist — the surgeons, nurses, anesthesiologists and other staff members — need to buy in to the project and drive its implementation. "If you don't empower front-line staff, you're not gong to be successful at using the checklist and improving outcomes," Dr. Ellner says. Patient safety leaders need to communicate the importance of the checklist to team members and give them the authority to implement it.

Dr. Ellner and an OR team use the surgical safety checklist.
Dr. Ellner and an OR team use the safety checklist.
2. Promote communication. Communication during any medical procedure is crucial. During a surgery, communication may become strained or more difficult due to the stressful environment. When a new process, such as a checklist, is added to the mix, clear communication can take a nosedive.

Dr. Ellner ran approximately 40 training exercises to teach physicians and staff how to communicate effectively with the checklist. The training exercises involved role playing in different scenarios. "The goal was to come to a dialogue where they could communicate their message and reach common ground," he says. Physicians and staff also played different roles to understand others' perspectives.

This exercise taught physicians and staff humility and the need to listen to each other, which is crucial when developing a just culture, according to Dr. Ellner. Training OR team members to communicate clearly with the checklist in a stressful situation helped create a safe environment in which people feel comfortable voicing patient safety concerns without fear of retribution.

3. Collect, analyze and apply data. Once the checklist is fully adopted, leaders need to collect data on outcomes and benchmark performance against similar organizations. Dr. Ellner compares data using the American College of Surgeons' National Surgical Quality Improvement Program — a database of participating hospitals' surgical outcomes. "Having data is so valuable because you can identify areas where you need to focus on implementing these quality initiatives," he says. Hospital leaders need to feed back this data to the OR team so they can adapt their checklist process accordingly.

Using the surgical safety checklist, Saint Francis Hospital and Medical Center cut its surgical infections by 75 percent. In addition, the hospital has not had any cases of post-surgical urinary tract infections for more than a year.

More Articles on Surgical Safety:

Study: Surgical Site Infection Rates Lower in U.S. vs. 30 Countries
Study: Printed Surgical Safety Checklist Improves Item Validation Rate

10 Sterile Processing Essentials From ECRI Institute

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