J. Roybal3, K. Tsao1,9, S. Rangel4,7, M. Ottosen2, D. Skarda6,8, L. Berman5 1UTHealth Medical School,Pediatric Surgery,Houston, TX, USA 2UT Houston-Memorial Hermann,Center For Healthcare Quality And Safety,Houston, TX, USA 3Ochsner Hospital For Children,Pediatric Surgery,New Orleans, LA, USA 4Boston Children’s Hospital,Pediatric Surgery,Boston, MA, USA 5Nemours/Alfred I. DuPont Hospital For Children,Pediatric Surgery,Wilmington, DE, USA 6Primary Children’s Hospital,Pediatric Surgery,Salt Lake City, UT, USA 7Harvard Medical School,Pediatric Surgery,Boston, MA, USA 8University Of Utah,Pediatric Surgery,Salt Lake City, UTAH, USA 9Children’s Memorial Hermann,Pediatric Surgery,Houston, TX, USA
Introduction: Safety initiatives, such as peri-operative checklists, aim to create a safe environment for patients undergoing surgery. Attitudes toward and adherence to the checklist among providers affect its ability to prevent harm. The pediatric surgeon’s perception of the importance of the surgical checklist, and its perceived role in improving patient safety, is unknown. We designed a survey to assess safety knowledge, attitudes and perceptions of North American pediatric surgeons, and to specifically gauge the “buy-in” of the American Pediatric Surgical Association (APSA) membership on checklists.
Methods: An online survey of APSA members was conducted to evaluate utilization of and attitudes towards surgical safety checklists (SSCs). Surgeons’ perceptions of SSC’s, including the components that make them effective as well as barriers to participation, were measured. Closed and open-ended questions were designed to quantify surgeon participation in the pre-induction, pre-incision, and post-operative debriefing checklists, and to describe surgeons’ attitudes about the effectiveness of checklists. Standard frequency analyses were performed, and content analysis was used to evaluate open ended responses. In addition to the survey, a literature search was carried out to identify systematic reviews of safety checklists in surgery and any studies focusing on the use of checklists in the pediatric surgical population.
Results: The survey response rate was 38% (353/928). Use of the SSC was reported by 93.6% of respondents, but only 54.7% felt that checklists improve patient safety, and only 62.6% would want it used in their own child’s operation. Being in a safety position was the only respondent characteristic that correlated with believing that checklists improve patient safety or wanting the checklist used in one’s own child’s operation. Reasons most commonly cited for skepticism around checklist efficacy included length of the checklist process, distraction from thoughtful patient care, and lack of data to support use. For the literature review, 10 manuscripts met inclusion criteria and were reviewed in detail. Only one study addressed pediatric surgery patients.
Conclusion: Most pediatric surgeons participate in surgical safety checklists at their institutions, but many question their benefit. While data is lacking on the morbidity and mortality benefit of surgical safety checklists in the pediatric population, checklists have been shown to improve communication, promote teamwork, and identify errors. Checklists should be regarded as key elements in improving peri-operative safety culture.