The WHO Surgical Safety Checklist Metastar January 25 th, 2011.
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Transcript of The WHO Surgical Safety Checklist Metastar January 25 th, 2011.
The WHO Surgical Safety Checklist
Metastar
January 25th, 2011
Discussion Topics
• Checklist background
• Checklist spread
The ProblemThe Problem
The 3 Central Problems in Surgical Safety Throughout the World
• Unrecognized as public health issue
• Lack of data on surgery and outcomes
• We know what to do, but we don’t do it consistently
Global Annual Procedure Rates
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
Childbirths Major Surgery
Source: WHO, 2008
The Safe Surgery Saves Lives The Safe Surgery Saves Lives ProgrammeProgramme
Guiding Principles
• Simple
• Widely applicable
• Measurable
• Address serious and avoidable surgical complications
• Zero harm from the Checklist
Process Leading to Checklist• Brainstorming• Analyzing• Expert Meeting• Small Working Groups• Assembling• Small Scale Testing/Modification• Pilot Study• Launch and Dissemination
Four Categories for Surgical Standards:
CONTROL OF INFECTION AND
CONTAMINATION
ANESTHESIA AND PATIENT
MONITORING
SURGICAL OPERATOR QUALITY ASSURANCE
Why a Checklist?
Pilot Study
London, UK EURO EMRO
WPRO I
SEARO
AFRO
PAHO I
Amman, JordanToronto, Canada
New Delhi, India
Manila, Philippines
Ifakara, Tanzania
WPRO II
Auckland, NZ
PAHO II
Seattle, USA
International Pilot Study 8 Evaluation Sites - Nearly 8,000 Patients
Site CasesInpatient
ComplicationInpatient
Death
1 524 11.6% 1.0%
2 357 7.8% 1.1%
3 497 13.5% 0.8%
4 520 7.5% 1.0%
5 370 21.4% 1.4%
6 496 10.1% 3.6%
7 525 12.4% 2.1%
8 444 6.1% 1.4%
Total 3733 11.0% 1.5%
Outcomes at Baseline
Results - Process Measures Baseline Checklist P-value
Objective Airway Evaluation 64.0% 77.2% <0.001
Abx at 0-60 Mins Except Dirty Cases
56.1% 82.6% <0.001
Verbal Pt/Site Confirmation 54.4% 92.3% <0.001
Two IVs /Central Line if EBL≥500
58.1% 63.2% 0.32
Pulse Oximeter 93.6% 96.8% <0.001Sponge Count 84.6% 94.6% <0.001All Six Safety Indicators Done
34.2% 56.7% <0.001
Results – All SitesBaseline Checklist P value
Cases 3733 3955 -
Death 1.5% 0.8% 0.003
Any Complication 11.0% 7.0% <0.001
SSI 6.2% 3.4% <0.001
Unplanned Reoperation 2.4% 1.8% 0.047
Change in Death and Complications by Income Classification
Change in Complications
Change in Death
High Income 10.3% -> 7.1%* 0.9% -> 0.6%
Low and Middle Income
11.7% -> 6.8%* 2.1% -> 1.0%*
* p<0.05
Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229)
The checklist was easy to use 78.6%
The checklist improved operating room safety
79.0%
The checklist took a long time to complete 18.3%
Communication was improved through use of the checklist
84.3%
The checklist helped prevent errors in the operating room
78.2%
If I were having an operation, I would want the checklist to be used
92.6%
A Deeper Look at the Checklist
TEAMWORKTEAMWORK
What is not here?
Joint Commission Universal Protocol
SCIP Measure
WHO
Joint Commission Universal Protocol
SCIP Measures
Joint Commission Universal Protocol
WHO
WHO
Standard of Practice
WHO
WHO
Where is the Checklist Today
3,924 as of 12-8-2010
1,789
3,924 as of 12-8-2010
1,789
Participating Hospitals: 3,924
Actively Using the Checklist: 1,789
For More Information :
www.safesurg.org
www.who.int/safesurgerywww.ihi.org
Email us at: [email protected]
