Surgical Checklist Implementation Project

Project summary

Background and methods

Earlier this year, the WHO Safe Surgery Checklist was modified and mandated for use in NHS Trusts in England, by the NPSA. Imperial College London and Imperial College Healthcare NHS Trust have recently been awarded an NIHR grant to undertake an in-depth national evaluation of the Checklist in England, with emphasis on Checklist usability and contribution to safer care delivery. There are two programmes of research within this evaluation:

1. Evaluating the diffusion of the Checklist and its usage across NHS organisations → Theatre and non-theatre staff will be asked to provide their opinions on Checklist usage, content and efficacy. 20 Trusts will do this via an online survey, and, of these, 10 Trusts will complete in-depth telephone interviews. Additionally, observations will be carried out in 5 of the Trusts to assess variation in Checklist usage and the impact this has on non-technical skills in theatre (i.e. team-work behaviours).

2. Evaluating the impact of the Checklist on clinical processes and outcomes →Intra and post-operative outcome data will be collected in the same 5 Trusts participating in the observations, for an overall total of 7,200 patients in the specialities of general, orthopaedic and urology.

These programmes encompass the following overall aims:

• To find out how the Checklist is currently used in operating theatres
• To investigate theatre and non-theatre staff’s perceptions of Checklist usage and efficacy.
• To assess the barriers and enablers to successful implementation
• To correlate these findings with measures of safety culture in the relevant Trusts

• To assess how variation in Checklist usage and perceptions relate to intra-operative and post-operative outcomes

Patient perspective component

We have recently launched a side-arm study looking at patient's views regarding the Checklist. We are showing 250 patients who have recently had surgery two videos; one depicting how the Checklist is used during an operation, and another depicting the equivalent safety checks that took place before the Checklist was introduced. We are then asking patients to fill in a 20 item questionnaire providing their views on the Checklist (encorporating their general attitude towards it, the perceived advantages and the perceived disadvantages) and their views on patient involvement in implementing safety interventions in hospitals in general.