D. N. Supak1,2, M. A. Bartz-Kurycki1,2, K. T. Anderson1,2, S. N. Wythe1,2, G. M. Garwood1,2, R. F. Martin1,2, R. Gutierrez1,2, A. L. Kawaguchi1,2, K. P. Lally1,2, K. Tsao1,2 1McGovern Medical School, University Of Texas Health Sciences Center At Houston,Pediatric Surgery,Houston, TX, USA 2Children’s Memorial Hermann Hospital,Houston, TX, USA
Introduction: Patient and parent engagement in healthcare has been shown to improve compliance and outcomes in many medical disciplines, but no literature exists regarding parent engagement in the perioperative process. The World Health Organization surgical safety checklist (SSC) recommends including the parents of pediatric patients in checklist completion. At our children’s hospital, the pre-induction SSC is conducted in pre-operative holding with anesthesia, nursing and often with parents. We hypothesized that better checklist compliance would be observed when parents were engaged in checklist performance.
Methods: An observational study of pre-induction checklist adherence during non-emergent pediatric operations was performed from 2016 to 2017 during two separate 8-week periods. Adherence was defined as verbalization of each checkpoint with or without parent confirmation. Six of 13 checkpoints (patient identification, procedure, surgical site marked, weight, allergies and NPO status) containing information relevant to parental knowledge were evaluated for staff confirmation with parents. Trained observers assessed parent engagement based on: parents off their phones, not distracted, positive body language, eye contact and demonstrating an understanding of the checkpoint. Chi-square test and linear regression were used for analysis. P-value <0.05 was significant.
Results: Over the study period, 459 pre-induction checklists were observed with at least partial completion in 93.3% of cases with kappa >0.7. The mean proportion of checkpoints completed was 64.6% ± 31.1% and the proportion of fully completed pre-operative checklists was only 18.3%. Parents were present in 82% of cases and at least 1 checkpoint was confirmed with parents in 79% of checklists. Pre-induction checklist adherence was better when parents were present compared to when absent (p<0.001 for all checkpoints). Linear regression demonstrated a 1.2 (95%CI 1.0-1.3) increase in pre-induction adherence for every unit increase in parent engagement (Figure). Furthermore, meaningful completion of checkpoints by staff confirmation with parents differed significantly based on parent engagement with 93.9-100% of staff confirmation of checkpoints occurring with engaged parents compared to 0.3-6.1% in parents deemed not engaged (p<0.001).
Conclusion: Pre-induction SSC performance remains a challenge, as less than one-fifth of checklists were completed in full. However, dramatic improvement in compliance and staff confirmation of checkpoints was observed when parents were present for and engaged in the checklist process. Creating a process and training operative teams how to engage parents may increase checklist compliance and improve patient safety.
