@article{Mayer:2015:10.1097/SLA.0000000000001185,
author = {Mayer, EK and Sevdalis, N and Rout, S and Caris, J and Russ, S and Mansell, J and Davies, R and Skapinakis, P and Vincent, C and Athanasiou, T and Moorthy, K and Darzi, A},
doi = {10.1097/SLA.0000000000001185},
journal = {Annals of Surgery},
pages = {58--63},
title = {Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study},
url = {http://dx.doi.org/10.1097/SLA.0000000000001185},
volume = {263},
year = {2015}
}

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TY  - JOUR
AB  - OBJECTIVE: To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. BACKGROUND: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. METHODS: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. RESULTS: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37-0.87, P < 0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. CONCLUSIONS: Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.
AU  - Mayer,EK
AU  - Sevdalis,N
AU  - Rout,S
AU  - Caris,J
AU  - Russ,S
AU  - Mansell,J
AU  - Davies,R
AU  - Skapinakis,P
AU  - Vincent,C
AU  - Athanasiou,T
AU  - Moorthy,K
AU  - Darzi,A
DO  - 10.1097/SLA.0000000000001185
EP  - 63
PY  - 2015///
SN  - 1528-1140
SP  - 58
TI  - Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study
T2  - Annals of Surgery
UR  - http://dx.doi.org/10.1097/SLA.0000000000001185
UR  - https://journals.lww.com/annalsofsurgery/Fulltext/2016/01000/Surgical_Checklist_Implementation_Project__The.10.aspx
UR  - http://hdl.handle.net/10044/1/22141
VL  - 263
ER  - 

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