The success of a surgical checklist, designed to be a simple and inexpensive way to cut post-operative infection rates and save patient lives, may depend on a number of factors, including leadership support, how the hospital adapts the checklist and buy-in from the staff who use it, according to an article in Nature.
Researchers found a variety of factors can influence a checklist's success or failure, ranging from the attitudes of staff to the way that administrators introduce the tool, the report said. The research follows a study released earlier this year that found surgical safety checklists didn't improve operative mortality, readmission rates, and emergency department visits within 30 days after discharge at 101 Canadian hospitals.
While some experts suspect that the failure to replicate original success could be tied to how the initial trials or follow-up studies were designed, researchers also believe poor implementation is a factor. After the National Health Service in England mandated use of the surgical checklist developed by the World Health Organization, researchers found that staff often were not using it properly. For instance, staff used the checklist in 97 percent of cases, but completed it only 62 percent of the time.
When operating room staff at 10 hospitals were interviewed, half of them said staff resisted or failed to complete the checklist; 34 percent said the checklist was inappropriate or illogical; and 29 percent believed the checklist was a waste of time.
To improve the success of the checklists, the report recommends:
Proper training: Provide training and solicit feedback from staff. Make sure staff feel invested in the checklist and know how to use it properly. Explain why they must use the checklist, including sharing the evidence behind it. Provide feedback so staff can see that their efforts have paid off, such as how use of the checklist decreased hospital infection rates.
Leadership, staff support: Get buy-in from staff, such as senior surgeons and anesthesiologists, so they do not resist implementation efforts.
Modification of checklists: Ensure the checklist does what it is intended to do and is properly worded, appropriate for the procedure and not redundant with other safety checks, the report said. Experts recommend hospitals modify standard checklists so the tool fits the organization.
"The clear lesson for hospital leaders is that they cannot just dump a stack of checklists in an operating room--they must observe them being used. Are team members all present? Are they rushing, or skipping steps? If so, then the lapses should be discussed and addressed," the report said.
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