Implementation challenges can hinder the effectiveness of the WHO Surgical Safety Checklist (SSC). This study describes the validation of the Checklist Performance Observation for Improvement (CheckPOINT) tool to assess SSC implementation fidelity. Based on testing in simulated and real-life clinical practice, researchers found that that the tool can reliably assess implementation fidelity and identify opportunities for improvement.

… safe delivery of patient care. This commentary presents a framework for new physician managers to address disruptive … future disruption though intentional training and building a culture of safety. … Goodwin C, Haas S, Berry W. What I wish I’d known: how experienced physician …

Labor and delivery is a high-risk care environment. This study evaluated a quality improvement initiative (TeamBirth) designed to promote shared decision-making and safety culture in labor and delivery. This mixed-methods study included both clinicians and patients at four hospitals and found that the program was feasible, increased the use of huddles, and had no negative effects on patient safety.

… safety and the surgical safety checklist at 10 years; a multinational survey. Ann Surg. 2021;2(3):e075. …

The World Health Organization (WHO) surgical safety checklist is widely used in surgical settings to prevent errors. This multinational panel representing multiple clinical specialties identified 16 recommendations for checklist content modification and implementation during the COVID-19 pandemic. These recommendations exemplify how the checklist can be adapted to meet urgent and emerging needs of surgical units by targeting important processes and encouraging critical discussions.

… Jt Comm J Qual Patient Saf … As part of a quality improvement initiative to enhance surgical … 20 physicians to understand potential areas of risk when a physician begins working in an unfamiliar setting.   …

… BMJ (Clinical research ed.) … BMJ … Checklists are a popular yet controversial strategy for improving the safety … debate the weaknesses and strengths of checklists through a discussion of the evidence . …

Ambulatory surgery centers are increasingly utilized to provide surgical care to patients. Quality improvement approaches utilized in the inpatient setting may need to be modified or adapted to be applicable in the ambulatory surgery environment. Researchers describe efforts to implement a surgical safety checklist and infection control techniques across 665 ambulatory surgery centers recruited for the study. They identified several barriers and conclude that the unique aspects of ambulatory surgery centers must be taken into account when implementing quality improvement initiatives.

This study in the Health Affairs patient safety theme issue examines the implementation of surgical safety checklists. Checklists have been shown to improve patient outcomes in randomized control trials, but implementation studies have not consistently demonstrated similar improvements. In this statewide initiative, implementation of the checklist varied significantly among sites. Factors associated with more successful implementation included greater leadership participation, frontline engagement, and more frequent activities for all involved groups, including surgeons, nurses, technicians, and administrators. Sites that invested more funding and time also saw greater checklist implementation. The authors conclude that hospitals that participated more did better. Past PSNet interviews with Lucian Leape and David Urbach discussed their perspectives on surgical safety checklists.

Checklists have been shown to improve surgical outcomes in clinical trials, but their effectiveness in real-world settings is variable. This implementation study examined factors related to checklist use in the operating room for crises rather than routine practice. Investigators surveyed individuals who downloaded a checklist from two websites about whether they used a checklist regularly in specific clinical situations. Thorough checklist implementation, leadership support, and dedicated staff training time led to more regular use of the checklist. Conversely, frontline resistance and lack of clinical champions undermined checklist use. The authors conclude that optimizing organizational conditions should increase the use of checklists during crises in operating rooms. Past PSNet interviews with Lucian Leape and David Urbach discussed their perspectives on surgical safety checklists.

Changes in organizational process and governance can create downstream conditions that result in failures. This commentary explored how system expansion affects safety. The authors highlight the need for leadership to use system data to plan for and manage the impact of the resultant infrastructure and patient population changes on care delivery.

Physicians who receive more patient complaints about communication and behavior are more likely to face malpractice claims. This study examined whether results from surgeons' 360-degree reviews, in which team members evaluate a range of professional attributes and behaviors, were associated with risk of malpractice claims. Surgeons with worse performance for attentiveness, informing others, and considering others' suggestions had a significantly higher risk for malpractice claims. Surgeons in the highest 10% for the negative behaviors of snapping at or talking down to others also were more likely to have malpractice claims. These results echo prior studies of physician behavior and malpractice risk. The authors suggest that addressing negative behaviors among surgeons could mitigate malpractice risk. A previous WebM&M commentary discussed patient complaints as safety surveillance.

Establishing a robust culture of safety, in which all staff feel free to voice concerns without fear of reprisal and leadership explicitly prioritizes safety, is crucial to safety improvement efforts. The most successful safety improvement programs have all explicitly prioritized enhancing safety culture. This study reports on the baseline results of a program that sought to improve surgical safety at hospitals in South Carolina. Safety culture was assessed among operating room personnel in 31 hospitals using a validated instrument. The investigators found a relatively robust association between better perceived safety culture and lower 30-day postoperative mortality. Studies in other clinical settings have found similar results. The hospitals involved in this study subsequently participated in a program to implement the Surgical Safety Checklist, which resulted in a significant improvement in mortality among participating hospitals compared to nonparticipating hospitals. A recent PSNet interview with Dr. Mary Dixon-Woods discussed the evolving concept of safety culture.

… the International Society for Quality in Health Care … Int J Qual Health Care … This qualitative study used data from …

… of surgery … Ann Surg … The large surge in opioid use is a serious patient safety problem. This retrospective study … opioid overdose increased over time. Patients with a substance abuse history were more likely to experience a postoperative opioid overdose, but hospital characteristics …

… clinical settings have been mixed. This study reports on a voluntary, statewide collaborative program to implement a surgical safety checklist in South Carolina hospitals. Participating sites undertook a multifaceted process to support checklist implementation …

… World journal of surgery … World J Surg … Checklists are widely utilized in health care to … in mortality for the overall study population, they found a 50% reduction in mortality for patients with more severe … trauma injuries after implementation of the program. A prior PSNet perspective discussed components of an …

… Journal of the American College of Surgeons … J Am Coll Surg … Although checklists have been shown to … that teamwork is critical to checklist implementation. A PSNet interview discussed the challenges of implementing …

Surgical checklists have been associated with reduced morbidity and mortality in randomized trials, but real-world implementation has not always resulted in improvement. This pre-post study reports on an initiative to implement surgical checklists in South Carolina hospitals. Investigators surveyed surgical personnel before and after checklist implementation. Compared with the pre-intervention responses, measures of teamwork improved, and 54% of participants reported effective checklist compliance. The study did not report on changes in patient outcomes after checklist introduction, which would substantiate calls for implementing checklists widely. A PSNet interview with Dr. Lucian Leape discussed his perspective on checklists and patient safety.