P080: PERCEPTIONS OF WHO SURGICAL SAFETY CHECKLIST WHEN IMPLEMENTED BY THE MULTIDISCIPLINARY OR TEAM
Benjamin Eslahpazir, MD1; Bin Zhu, MD2; Huan Gao, MD3; Xiangyong Zhou, MD4; Yu Liu, MD5; Gary Huang, MD5; Jeffrey Huang, MD1; 1HCA Healthcare/USF COM GME/Oak Hill Hospital; 2Peking University International Hospital; 3Fangcheng County Hospital; 4The Zhejiang University Second Affiliated Hospital; 5Peking Union Medical College Hospital
BACKGROUND: Since its launch in 2008, the WHO Surgical Safety Checklist (WHO SSC) has been implemented across institutions worldwide. However, its influence on surgical outcomes remains unclear with respect to quality of implementation and adherence at each facility. A cross-sectional survey study was performed to assess level of clinical motivation for routine performance of the surgical safety checklist across multiple institutions.
METHODS: A survey was designed on the basis of three parts of the surgical safety checklist and forming 23 questions. It covers the three main processes of safety check: (1) before anesthesia induction, (2) before operation start and (3) before patient leaving the operating room. From March to April 2019, the questionnaire was sent to the members of the Chinese-based online New Youth Anesthesia Forum through the WeChat® social media platform. Answers were completed by mobile phones or desktop computers. Each WeChat ID number allowed only one answer for each individual participant.
RESULTS: A total of 3943 members read the questionnaire invitation, of which 2121 members participated to completion with an overall completion rate of 53.8%. 28% of participants were trainees (medical students and residents) while the remaining 72% were practicing physicians (40% attendings, 32% division chiefs). The vast majority (93%) of operative cases were preceded by WHO SSC prior to induction of anesthesia but had lower rate of use (78%) prior to start of surgery. There were also reported high rates of list item omissions at 36.4% during these steps. In particular, key information regarding the surgery communicated by the surgeon was routinely provided only 18% of the time and a similar 18% frequency by the anesthesiologist regarding patient-specific concerns prior to inducing anesthesia. Teams completed an omission-free end-of-case checklists with only 44% frequency. 56% of medical teams were described as careful when performing verification checks while the remaining 37% checked in a hurry and 7% checked with insufficient understanding of patient’s condition. Even though respondents perceive surgeons as most familiar with the patient, surgeons led checklists at a frequency of 5.3%, deferring to anesthesiology 59% or OR nurse 36% of the time.
CONCLUSION: High rates of pre-anesthesia participation is followed by significant stepwise decrease in participation prior to start of surgery as well as prior to patient leaving the OR. High rates of list item omissions and lack of care during checklist performance was reported. This study identifies major gaps in proper implementation of the WHO SSC despite widespread adoption.