Abstract
Background
The World Health Organization's (WHO) surgical safety checklist is meant to be customized
to facilitate local implementation, encourage full-team participation, and promote
a culture of safety. Although it has been globally adopted, little is known about
the extent of checklist modification and the type of changes made.
Methods
Nonsubspecialty surgical checklists were obtained through online search and targeted
hospital requests. A detailed coding scheme was created to capture modifications to
checklist content and formatting. Descriptive statistics were performed.
Results
Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those
in our sample contained more lines of text (median: 63 [interquartile range: 50-73]
versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special
equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added
by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items.
The most frequently removed item was the pulse oximeter check (removed in 75%), followed
by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's “Anticipated
Critical Events” section, which is intended for exchanging critical information. The
surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified
registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub
in 79%.
Conclusions
Checklists are highly modified but often enlarged with items that may not prompt discussion
or teamwork. Of concern is the frequent removal of items from the WHO's “Anticipated
Critical Events” section.
Keywords
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Article info
Publication history
Published online: October 24, 2018
Accepted:
September 11,
2018
Received in revised form:
May 29,
2018
Received:
May 29,
2018
Footnotes
Meeting presentation: Results in this manuscript were initially presented as an oral presentation at the 13th Annual Academic Surgical Congress cosponsored by the Association for Academic Surgeons and the Society of University Surgeons, which was held from January 30 to February 1, 2018, in Jacksonville, Florida.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
