Using the surgical safety checklist

The use of checklists in several different areas of health care has increased greatly in recent years. Enthusiasm for adopting such tools in the perioperative domain was bolstered by a high-profile publication in 2009. Following implementation of the World Health Organisation (WHO) Surgical Safety Checklist at various centres around the world, Haynes et al. demonstrated an overall reduction in post-operative complications and mortality among surgical patients. These results spurred adoption of the WHO Surgical Safety Checklist in many hospitals. For example, de Vries et al., with members of the Surgical Patient Safety System Collaborative Group, demonstrated reduced mortality by introducing a ‘comprehensive, multidisciplinary surgical safety checklist’. More recently, van Klei and colleagues showed similarly improved 30-day outcomes after adoption of the WHO Surgical Safety Checklist in a Dutch tertiary care hospital. This group also demonstrated an association between completion of the Surgical Safety Checklist and post-operative mortality: full checklist completion resulted in statistically significant reductions in mortality compared with partial or non-compliance with the checklist. The authors of these studies postulated that improvements obtained after use of the checklist might have arisen from enhanced teamwork, communication, as well as attitudes germane to patient safety culture in the complex entity that is the perioperative environment. Of all safety-critical industries, aviation has the greatest history and experience with checklists. However, the purpose of the checklists, as introduced to aviation in the 20th century, was not to enhance communication but ‘to help the pilot avoid procedural errors’, for example, before take-off and landing. Expecting a tool, like a checklist, to provide a simple, inexpensive fix and overcome the multifactorial patient safety challenges faced by health-care teams is problematic. Deficiencies in the sociocultural infrastructure and practices of health care today are unlikely to be augmented by the checklist alone. Thus, assessing and quantifying the attitudes of the ‘sharp-end’ users of the checklist – those team members directly influenced by existing hierarchical and communication norms of the institution – can help evaluate a checklist’s effect. As previously published in Acta Anaesthesiologica Scandinavica, Böhmer et al. assessed staff members’ points of view about the quality of interprofessional cooperation, staff satisfaction, and achieving perioperative safety standards before and 3 months after the introduction of a surgical safety checklist. The authors were able to show that ‘cognizance of the names and functions of the individual operating room (OR) staff members, verification of the patient’s written consent for surgery, indication for antibiotics before the surgical incision, and the quality of interprofessional cooperation were rated more positively’. In this edition of the Journal, Kindermann, Böhmer and colleagues now report on the ‘Longterm effects of a perioperative safety checklist from the viewpoint of personnel’. As a follow-up to previous work, the authors present data assessing staff satisfaction and interprofessional communication 18 and 24 months after surgical safety checklist use at their institution. To date, this original article provides the longest follow-up evaluation in health care