South Carolina Hospitals Commit to Implement Surgical Safety Checklist by 2014

Every hospital in South Carolina, led by the South Carolina Hospital Association, has vowed to implement the use of the World Health Organization's Surgical Safety Checklist in all operating rooms by 2014, as part of Safe Surgery 2015, an initiative spearheaded by Atul Gawande, MD, and the Harvard School of Public Health.

Safe Surgery 2015

South Carolina was chosen as the lead state for state-wide implementation of the Checklist due to its high participation in the Institute for Healthcare Improvements' 2009 Surgical Safety Checklist Sprint, a pilot aimed at having every hospital in the U.S. test the Checklist at least one time with one OR team. Eighty percent of South Carolina hospitals signed up in the initial testing period, compared to 25 percent nationally, says Rick Foster, MD, senior vice president for quality and patient safety at the South Carolina Hospital Association.

Hospitals were encouraged to participate in the testing as part of the SCHA's "Every Patient Counts" program, a partnership committed to improving patient safety and quality within South Carolina hospitals. The program has four aims: 1) create an organizational culture of safety with engaged leadership, 2) actively improve the quality and outcomes of evidence-based medical care 3) eliminate medical errors and adverse events and 4) establish a patient-centered environment of care with open and transparent communication.

To aid hospitals in implementing the Checklist, SCHA in partnership with Dr. Gawande's Safe Surgery 2015 team, called upon hospitals in the state to form a leadership team dedicated to disseminating use of the Checklist. Each hospital's team is composed of a surgeon, anesthesiologist and administration champion in addition to other members who participate in weekly calls with SCHA. SCHA and Dr. Gawande's team provide hospitals with a template checklist and other resources but encourage each hospital to tailor the Checklist to their own unique circumstances. "We're not just someone on the other end telling them what to do," says Dr. Foster. "We want hospitals to share their individual successes as a way to spread use of the Checklist."

Rapid cycle implementation
Each hospital is then encouraged to use a rapid cycle model to begin spreading the use of the Checklist in its own facility. "Start piloting it on one or several surgical teams and build a larger group of champions," says Dr. Foster. "If you need help with resistant surgeons, connect them with these doctor champions."

Dr. Foster says the most resistance from physicians usually occurs around requiring a dedicated time out (as opposed to a nurse reading the checklist while others in the room attend to other tasks) and team member introductions, but he counters the surgical environment is so complex that taking a dedicated time out is important to ensure everyone in the room is on the same page. He explains that a dedicated time out to debrief both before incision and after the surgery should be minimum requirements of any Checklist process.

Another important goal of the time out is to encourage a team-based environment. According to Dr. Foster, a team built on active communication is better able to respond to problems that may arise than a group of individuals. "It's not just the fact they say their name. If an [OR staff member] speaks up before surgery, they’re more comfortable speaking up during surgery," says Dr. Foster. 

SCHA will track the progress of its hospitals by asking them to self report use of the Checklist. Surgical directors will be asked to survey ORs and report back, and surgical staff will also be surveyed. SCHA will also analyze outcome measures, such as mortality rates, surgical site infections and return to surgery on the same admission to determine if Checklist use led to improvements.

Dr. Foster hopes South Carolina can serve as an example to others states as they work to implement the use of the Checklist across their own states. He believes the Checklist is an important and simple way to prevent adverse events and improve the quality of care patients receive.

Related Articles on Surgical Checklists:
6 Steps to Build of a "Culture of Safety" in the Hospital Operating Room
Nevada Senate Approves Bill Requiring Patient Safety Checklists

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