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Effectiveness of the surgical safety checklist in a high standard care environment


Lübbeke, Anne; Hovaguimian, Frederique; Wickboldt, Nadine; Barea, Christophe; Clergue, François; Hoffmeyer, Pierre; Walder, Bernhard (2013). Effectiveness of the surgical safety checklist in a high standard care environment. Medical Care, 51(5):425-429.

Abstract

BACKGROUND: Use of surgical safety checklists has been associated with significant reduction in postoperative surgical site infection (SSI), morbidity, and mortality.
OBJECTIVE: To evaluate the effectiveness of an intraoperative checklist in high-risk surgical patients in a high standard care environment with long-standing regular perioperative safety control programs.
RESEARCH DESIGN: Quasi-experiment pre-post checklist implementation.
SUBJECTS: Surgical patients above 16 years with an American Society of Anesthesiologists (ASA) score 3-5 operated upon at a large tertiary hospital.
MEASURES: Unplanned return to operating room for any reason, reoperation for SSI, unplanned admission to intensive care unit, and in-hospital death within 30 days.
RESULTS: A total of 609 patients (53% elective, 85% ASA 3, mean age 70 y) were included before and 1818 after implementation (52% elective, 87% ASA 3, mean age 69 y), the latter with 552, 558, and 708 in period I, II, and III, respectively. Comparing preimplementation to postimplementation periods: unplanned return to operating room occurred in 45/609 (7.4%) versus 109/1818 (6.0%) interventions [adjusted risk ratios (RR) 0.82; 95% confidence interval (CI), 0.59-1.14]; reoperation for SSI in 18/609 (3.0%) versus 109/1818 (1.7%) interventions (adjusted RR 0.56; 95% CI, 0.32-1.00); unplanned admission to intensive care unit in 17 (2.8%) versus 48 (2.6%) interventions (adjusted RR 0.90; 95% CI, 0.52-1.55); and in-hospital death occurred in 26 (4.3%) versus 108 (5.9%) patients (adjusted RR 1.44; 95% CI, 0.97-2.14). Checklist use during 77 interventions prevented 1 reoperation for SSI.
CONCLUSIONS: A trend toward reduced reoperation rates for SSI was observed after checklist implementation in this high standard care environment; no influence on other outcome measures was observed.

Abstract

BACKGROUND: Use of surgical safety checklists has been associated with significant reduction in postoperative surgical site infection (SSI), morbidity, and mortality.
OBJECTIVE: To evaluate the effectiveness of an intraoperative checklist in high-risk surgical patients in a high standard care environment with long-standing regular perioperative safety control programs.
RESEARCH DESIGN: Quasi-experiment pre-post checklist implementation.
SUBJECTS: Surgical patients above 16 years with an American Society of Anesthesiologists (ASA) score 3-5 operated upon at a large tertiary hospital.
MEASURES: Unplanned return to operating room for any reason, reoperation for SSI, unplanned admission to intensive care unit, and in-hospital death within 30 days.
RESULTS: A total of 609 patients (53% elective, 85% ASA 3, mean age 70 y) were included before and 1818 after implementation (52% elective, 87% ASA 3, mean age 69 y), the latter with 552, 558, and 708 in period I, II, and III, respectively. Comparing preimplementation to postimplementation periods: unplanned return to operating room occurred in 45/609 (7.4%) versus 109/1818 (6.0%) interventions [adjusted risk ratios (RR) 0.82; 95% confidence interval (CI), 0.59-1.14]; reoperation for SSI in 18/609 (3.0%) versus 109/1818 (1.7%) interventions (adjusted RR 0.56; 95% CI, 0.32-1.00); unplanned admission to intensive care unit in 17 (2.8%) versus 48 (2.6%) interventions (adjusted RR 0.90; 95% CI, 0.52-1.55); and in-hospital death occurred in 26 (4.3%) versus 108 (5.9%) patients (adjusted RR 1.44; 95% CI, 0.97-2.14). Checklist use during 77 interventions prevented 1 reoperation for SSI.
CONCLUSIONS: A trend toward reduced reoperation rates for SSI was observed after checklist implementation in this high standard care environment; no influence on other outcome measures was observed.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:22 Jul 2013 06:44
Last Modified:05 Apr 2016 16:52
Publisher:Lippincott, Williams & Wilkins
ISSN:0025-7079
Publisher DOI:https://doi.org/10.1097/MLR.0b013e31828d1489
PubMed ID:23579353

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