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: safesurgery@hsph.harvard.edu