M. Jindal1,2, S. Cane3, C. Zheng2, L. M. Boyle1,3, S. A. Krevat3,4, W. B. Al-Refaie1,2,3 1Georgetown University Medical Center,Washington, DC, USA 2MedStar-Georgetown Surgical Outcomes Research Center,Washington, DC, USA 3MedStar Health,Washington, DC, USA 4MedStar Health Research Institute,Washington, DC, USA
Introduction: Despite extensive evidence emphasizing adherence to Safe Surgery Checklist (SSC), compliance among surgery team members varies widely. A greater understanding of providers’ expectations and outlook on the different components of SSC (including anesthesia sign-in, surgical timeout, and team debrief) is needed to gain deeper insights into non-adherence. The purpose of our study is to examine providers’ perception of SSC at a major metropolitan academic teaching hospital.
Methods: A SSC-focused questionnaire was developed by a multidisciplinary operating room (OR) safety committee and distributed to 154 providers including attending surgeons, anesthesiologists and certified nurse anesthetists via an online survey tool. The questionnaire had 14 questions in the form of multiple choice complemented with a comment box. Responses were collected anonymously for over a month. Questions inquired team members’ opinions about the importance and compliance of the individual components of the checklist, their perception of barriers to completion of checklists, and their training on performing the timeouts.
Results:The overall response rate was 40% (61/154). Among our respondents, 66% were surgeons, 63% were 30-50 years old, and 69% reported that they always completed all pertinent components of the SCC correctly. Although it is recommended for providers to be present for all three components of the SSC, only 36% reported adhering to this, while 46%, 5% and 19% reported being absent for anesthesia sign-in, surgical timeout, and team debrief, respectively. Majority of those absent from anesthesia sign-in were surgeons (27/29) and from team debrief were anesthesiologists (10/12).
When inquired about previous training on how to complete the SSC, 20% reported receiving no training on this subject at all, 43% only received informal training through observing other providers; an overall 35% believed there was a lack of education/information on this subject. Regarding barriers to completing SSC, 34% identified lack of time, 21% lack of training, 21% lack of awareness of the importance of SSC, and 16% lack of cue/reminders.
Conclusion:Our survey on a multi-specialty OR team found that providers’ perception of SSC may contribute to improved compliance. Among the leading causes of non-adherence were time constraints, lack of formal training in performing and awareness of the importance of SSC. These findings point to initiatives to address these causes as potential solutions to improve compliance.