Abstract
The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0–16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58–1.37) and 1.6% (RR 0.88; 95% CI 0.34–2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.
Similar content being viewed by others
References
Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144
Amalberti R, Auroy Y, Berwick D, Barach P (2005) Five system barriers to achieving ultrasafe health care. Ann Intern Med 142:756–764
Gawande AA, Thomas EJ, Zinner MJ, Brennan TA (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75
Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276
Catchpole K, Mishra A, Handa A, McCulloch P (2008) Teamwork and error in the operating room: analysis of skills and roles. Ann Surg 247:699–706
Lingard L, Espin S, Whyte S et al (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13:330–334
World Alliance for Patient Safety (2008) WHO guidelines for safe surgery. World Health Organisation, Geneva
WHO (2008) The Surgical Safety Checklist. World Health Organisation, Geneva. http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf. Accessed 5 August 2010
Haynes AB, Weiser TG, Berry WR et al (2009) A Surgical Safety Checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499
Khuri SF, Daley J, Henderson W et al (1995) The national veterans administration surgical risk study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 180:519–531
National Patient Safety Agency. (2009) Patient Safety Alert UPDATE. NPSA, London. http://www.npsa.nhs.uk/nrls/alerts-and-directives/alerts/safer-surgery-alert/. Accessed 5 August 2010
Torholm C, Broeng L, Jorgensen PS et al (1991) Thromboprophylaxis by low-molecular weight heparin in elective hip surgery. A placebo controlled study. J Bone Joint Surg Br 73:434–438
Pitto RP, Hamer H, Heiss-Dunlop W, Kuehle J (2004) Mechanical prophylaxis of deep-vein thrombosis after total hip replacement: a randomised clinical trial. J Bone Joint Surg Br 86:639–642
Warwick D, Friedman RJ, Agnelli G et al (2007) Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the global orthopaedic registry. J Bone Joint Surg Br 89:799–807
Blanco M, Clarke JR, Martindell D (2009) Wrong site surgery near misses and actual occurrences. AORN J 90:215–222
Reuther F (2009) Avoidance of wrong site surgery. Experiences by the introduction of measures for quality control and patient safety in a surgical casualty hospital. Unfallchirurg 112:675–678
Prokuski L (2008) Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg 16:283–293
Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88:943–948
Berenholtz SM, Pronovost PJ, Lipsett PA et al (2004) Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 32:2014–2020
Lingard L, Regehr G, Orser B et al (2008) Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anaesthesiologists to reduce failures in communication. Arch Surg 143:12–18
Sexton JB, Makary MA, Tersigni AR et al (2006) Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel. Anaesthesiology 105:877–884
Makary MA, Sexton JB, Freischlag JA et al (2006) Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 202:746–752
Taylor B, Slater A, Reznick R (2010) The surgical safety checklist effects are sustained, and team culture is strengthened. Surgeon 8:1–4
Sarker SK, Vincent C (2005) Errors in surgery. Int J Surg 31:75–81
Pitto RP, Young S (2008) Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance. Int Orthop 32:331–336
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sewell, M., Adebibe, M., Jayakumar, P. et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. International Orthopaedics (SICOT) 35, 897–901 (2011). https://doi.org/10.1007/s00264-010-1112-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-010-1112-7