M. A. Bartz-Kurycki1,2,3, K. T. Anderson1,2,3, K. M. Masada1,2,3, M. J. Ottosen1,2,3, J. Wang1,2,3, J. E. Abraham1,2,3, K. Tsao1,2,3 1McGovern Medical School, The University Of Texas Health Sciences Center At Houston,Department Of Pediatric Surgery,Houston, TX, USA 2Children’s Memorial Hermann Hospital,Houston, TX, USA 3Center For Surgical Trials And Evidence-based Practices (C-STEP),The University Of Texas Health Sciences Center At Houston,Houston, TX, USA
Introduction: The pre-induction surgical safety checklist (SSC) provides an opportunity to exchange and confirm critical information prior to surgery. Recent literature has shown that enhanced patient/parent engagement in healthcare can reduce adverse events and improve outcomes. In our children’s hospital, we conduct this phase in pre-operative holding with anesthesia and nursing, often in the presence of parents. There is a paucity of data evaluating parental involvement in this process. We aimed to describe the current state of parent engagement in the pre-induction SSC.
Methods: An 8-week observational study was conducted at a tertiary children’s hospital with convenience sampling of elective pediatric surgery operations. Trained observers evaluated the pre-induction SSC with attention to 6 of 17 checkpoints relevant to parental knowledge: patient identification, procedure, surgical site marked, weight, allergies and NPO status. Observers measured parental inclusion based on the perioperative team’s performance of the checklist with/without parent confirmation. New information provided by parents was recorded. Level of parental engagement was also determined with positive engagement exhibiting eye contact, positive body language and undivided attention during checklist proceedings. Anesthesia, nursing and parents were each interviewed post hoc for their perceptions of parental involvement during the checklist process. Cohen’s kappa statistic and Chi square test were used for analysis (p<0.05 was significant).
Results: 255 cases were observed and 68% of parents (n=174) were interviewed with a kappa of 0.85 (95% CI 0.79-0.88). The perioperative team completed 60.9% of checkpoints during the pre-induction SSC while only 36% were directly confirmed with parents (figure). 51 items of new information were provided by parents (range 0-3) with 23 items (45%) corresponding to measured checkpoints. Perceptions of parent engagement were mixed among the groups (p<0.01). During post-procedure interviews, almost all (98%) parents felt included in the checklist process. Similarly, anesthesia and nursing reported positive parental engagement in 72% and 89%, respectively. However, observers identified positive parent engagement in only 53% of cases.
Conclusion: Parental involvement in the pre-induction SSC can introduce new and important clinical information. Although almost all groups reported high levels of parental engagement and comfort in speaking up, observers identified parental engagement in only half of the interactions, suggesting opportunities for improvement. Identifying methods to create supportive perioperative environments and developing a parent-centered SSC would likely improve patient safety.
