Implementing and Evaluating the WHO Surgical Safety Checklist

Project summary

Background

In February 2009, the WHO Safe Surgery Checklist was modified and mandated for use in NHS Trusts in England, by the NPSA. Imperial College London and Imperial College Healthcare NHS Trust were awarded an NIHR grant to undertake an in-depth national evaluation of the Checklist in England, with emphasis on Checklist usability and contribution to safer care delivery.

Within this project we evaluated:

• The diffusion of the Checklist and its usage across NHS organisations: we carried out large numbers of surveys and interviews with NHS frontline and managerial personnel regarding their perceptions of the WHO Checklist – including how it is being used, its content and its efficacy. We also carried out more that 500 real-time observations of full surgical procedures to assess variation in Checklist usage and the impact this has on team-working in operating theatres and compliance with standard processes of care (e.g. antibiotic prophylaxis, patient warming).
• The impact of the Checklist on clinical outcomes: We collected patient outcomes from a total of 6,714 patients in the specialities of general, orthopaedic and urology.
• Patients' views regarding the Checklist: two videos; one depicting how the Checklist is used during an operation, and another depicting the equivalent safety checks that took place before the Checklist were shown to a sample of patients who recently had surgery. Patients were asked to provide their views on the Checklist and, more broadly, the potential for patient involvement in the safety of surgical care using a survey.

Pre-checklist

 

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Post-checklist‌

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Outputs

Publications

• Mayer EK, Sevdalis N, Rout S, Caris J, Russ S, Mansell J, Davies R, Skapinakis P, Vincent C, Athanasiou T, Moorthy K, Darzi A. Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical Outcomes After National Implementation: A Longitudinal Study. Ann Surgery. 2016 Jan;263(1):58-63.
• Russ, SJ, Sevdalis N, Moorthy K, Mayer EK, Rout S, Caris J, Mansell J, Davies R, Vincent C, Darzi A. A Qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England: lessons from the "Surgical Checklist Implementation Project". Ann Surgery. 2015 Jan;261(1):81-91.

Presentations 

• Russ S, Rout S, Sevdalis N, Moorthy K, Darzi A, Vincent C. Do Safety Checklists Improved Teamwork and Communication in the Operating Theatre? A Systematic Review. The 6th International Workshop on Behavioural Sciences Applied to Acute Care Teams, Copenhagen. Nov 2012 (poster presentation).
• Russ S, Sevdalis N, Rout S, Moorthy K, Mayer E, Vincent C, Darzi A. Staff Attitudes Towards Implementation of the WHO Surgical Safety Checklist in the UK: Time Matters. The 6th International Workshop on Behavioural Sciences Applied to Acute Care Teams, Copenhagen. Nov 2012 (poster presentation).
• 'Following the safer surgery checklist'. Improving Patient Safety in Surgery Conference, RCS England: Supporting Surgeons in the Workplace programme, Birmingham, UK, Sep 2012.
• ‘Lessons from the Surgical Checklist Implementation Project’. East Midlands Strategic Health Authority: Regional Safe Surgery Meeting Coventry, UK, Oct 2012.
• Patient Safety First: Safer Surgery Week 2012. WEBINAR: A National Evaluation of the Implementation of the WHO Surgical Safety Checklist: Triumphs and Challenges. Sep 2012
• Shadow Clinical Board for Surgical Safety, Jan 2012
• Royal College of Surgeons Regional Representatives Conference, Nov 2011
• Association for Peri-operative Practitioners Conference (AfPP), Oct 2011