Nav: Home

Refusing access to surgery recovery area at a UK hospital unless WHO Safe Surgery Checklist is fully complete

May 26, 2016

New research showing that refusal to allow surgery teams to take the patient to the recovery room after surgery unless the full WHO Safe Surgery Checklist has been complete is a highly effective way to improve use of the checklist. The study is being presented at Euroanaesthesia 2016 (London, UK, 27-30 May), and is by Dr Rajkumar Rajendram, King's College London, United Kingdom (and formerly of the Royal Free Hospital, London, UK, where the research was carried out) and colleagues.

The WHO surgical safety checklist has been proven to improve compliance with safety standards and decreases complications from surgery. The 19-item checklist includes a variety of checks designed to improve safety, including the surgical team introducing themselves and their individual roles through to use of antibiotics and pulse oximeters. The checklist was introduced at the Royal Free Hospital, North London in 2010. However, in 2011 an audit of 520 patients over 3 weeks (15 April-6 May 2011) revealed poor compliance (57% complete; 6% not started). Although several serious untoward incidents highlighted the potential benefits of using the checklist, compliance remained poor. The aim of this audit was to improve use of the WHO checklist.

In this study, the key stakeholders within each operating theatre team were identified and surveyed informally. The key reasons cited for the failure to complete the WHO checklist were: lack of understanding, perceived lack of time and overall lack of communication, co-ordination and defined responsibility. Education on the checklist was delivered to theatre staff. After this, various initiatives were implemented using plan, do, study, act (PDSA) cycles to gauge their effectiveness. After each intervention the effect was assessed by a spot audit of 50-100 patients over a week.

In October 2011 a spot audit of 50 patients over a week found that utilisation of the checklist was still low (67% complete). Repeating the 50 patient spot audit unexpectedly detected a fall in use of the checklist (50% complete). The greatest deficiency was in completion of the surgical time out. However, highlighting this to theatre staff and allocating responsibility for the sign in, time out and sign out to the anaesthetists, surgeons and circulating scrub staff respectively resulted in an improvement (100 checklists; 94% complete). However this was unlikely to be sustained without the repeated audits which could not be continued indefinitely.

The authors found that, of the many initiatives that were tried, the most successful was to refuse the surgery team access to take the patient to the theatre recovery area post-surgery without a complete checklist. A month later a spot audit of 100 patients found that the WHO checklist had been completed for all cases. Subsequent spot audits have confirmed that this improvement has been sustained.

The authors conclude: "Despite clear evidence of benefit of the WHO surgical safety checklist human factors still limited use this checklist. The 'stick' philosophy of refusing entry to the theatre recovery area without a complete checklist was the key to its successful implementation at the Royal Free Hospital."

Dr Rajendram adds: "Behaviours will be repeated if they are rewarded with incentives, and stopped if they are penalised. Refusing transfer of the patient from the theatre to the recovery area if the checklist is incomplete prevents the progression of the operating list. This penalises the whole team rather than any one individual. The whole team is therefore incentivised to complete the checklist."

However, he adds there is no 'magic bullet' that is applicable in all circumstances for changing professional behaviour. Many barriers obstruct the implementation of evidence-based practices. To successfully implement new ways of working, the barriers must be recognised and addressed. Individuals, teams and organisations go through various stages in the process of change. Different interventions will be effective at different stages.

He concludes: "Although passive forms of education are generally considered ineffective, they formed part of our successful multifaceted change strategy. It is important to raise awareness of desired changes before providing incentives and penalties. The needs of stakeholders should be determined before behaviour change interventions are designed, so the intervention is tailored to their specific needs. Otherwise completion of the checklist will be simply reduced to a box ticking exercise and the effectiveness of the intervention will be greatly reduced."

ESA (European Society of Anaesthesiology)

Related Surgery Articles:

Bullies and their victims more likely to want plastic surgery
11.5 percent of bullying victims have extreme desire to have cosmetic surgery, as well as 3.4 percent of bullies and 8.8 percent of teenagers who both bully and are bullied -- compared with less than 1 percent of those who are unaffected by bullying.
Methadone may reduce need for opioids after surgery
Patients undergoing spinal fusion surgery who are treated with methadone during the procedure require significantly less intravenous and oral opioids to manage postoperative pain, reports a new study published in the May issue of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA).
New, persistent opioid use common after surgery
Among about 36,000 patients, approximately 6 percent continued to use opioids more than three months after their surgery, with rates not differing between major and minor surgical procedures, according to a study published by JAMA Surgery.
Refusing access to surgery recovery area at a UK hospital unless WHO Safe Surgery Checklist is fully complete
New research showing that refusal to allow surgery teams to take the patient to the recovery room after surgery unless the full WHO Safe Surgery Checklist has been complete is a highly effective way to improve use of the checklist.
Robotic surgery just got more autonomous
Putting surgery one step closer into the realm of self-driving cars and intelligent machines, researchers show for the first time that a supervised autonomous robot can successfully perform soft tissue surgery.
More Surgery News and Surgery Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#535 Superior
Apologies for the delay getting this week's episode out! A technical glitch slowed us down, but all is once again well. This week, we look at the often troubling intertwining of science and race: its long history, its ability to persist even during periods of disrepute, and the current forms it takes as it resurfaces, leveraging the internet and nationalism to buoy itself. We speak with Angela Saini, independent journalist and author of the new book "Superior: The Return of Race Science", about where race science went and how it's coming back.