Increasing Compliance With the Who Surgical Safety Checklist – A Regional Health System’s Experience

Matthew E Gitelis, BS, Adelaide Kaczynski, BS, Torin Shear, MD, Mark Deshur, MD, Annalyn Chiu, Mohammad I Beig, BBA, Meredith Sefa, Jonathan Silverstein, MD, Michael B Ujiki, MD. NorthShore University HealthSystem

Background: In 2009, NorthShore University HealthSystem adapted the World Health Organization (WHO) Surgical Safety Checklist (SSC) at each of its four hospitals. Despite evidence that SSC reduces intraoperative mistakes and increases patient safety, compliance was found to be low with the paper form. In fiscal year (FY) 2013, NorthShore integrated the SSC into the electronic medical record (EMR). The aim was to increase communication between operating room (OR) personnel and to encourage best practices during the natural workflow of surgeons, anesthesiologists, and nurses. The purpose of this study was to examine the impact of an electronic SSC on compliance and patient safety.

Methods: An anonymous OR observer selected cases at random and evaluated the compliance rate prior to the rollout of the electronic SSC. At the end of FY 2014, an electronic audit was performed to assess the compliance rate from data residing in the EMR. Random OR observations were also performed throughout FY 2014. Perioperative risk events, such as consent issues, incorrect counts, wrong site, and wrong procedure were compared before and after the electronic SSC rollout. A perceptions survey was also administered to NorthShore OR personnel.

Results: Compliance increased from 48% (n=167) to 94% (n=1015; p<0.001) after the SSC was integrated into the EMR. Surgeons (91% vs. 99%; p<0.001), anesthesiologists (89% vs. 100%; p<0.001), and nurses (55% vs. 95%; p<0.001) demonstrated an increase in compliance. A comparison between risk events in FY 2013 and FY 2014 showed a 32% decrease (p<0.01). Hospital wide indicators including length of stay and 30 day readmissions were trending lower. In a survey to assess the OR personnel’s perceptions, 76% of surgeons, 86% of anesthesiologists, and 88% of nurses believed the electronic SSC will have a positive impact on patient safety.

Conclusion: The WHO SSC is a validated tool to increase patient safety and reduce intraoperative complications. The electronic SSC has demonstrated an increased compliance rate, a reduced number of risk events, and most OR personnel believe it will have a positive impact on patient safety.