Use of surgical and radiology checklists in Australian hospitals: uptake, barriers and enablers
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(Published version)
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2014
Authors
Giles, K.
Munn, Z.
Schultz, T.
Deakin, A.
Aromataris, E.
Mandel, C.
Maddern, G.
Peters, M.
Pearson, A.
Runciman, B.
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Background: Surgical safety checklists have been shown to reduce deaths and complications from surgery in a range of countries. Although their effectiveness has been studied extensively, little is known about their use and the barriers and enablers to their use in Australia
Aims: The aims of this project were to investigate the use of safety checklists in surgery and radiology and understand what facilitates and what hinders their use in Australian hospitals.
Methods: A multi-method and phased research approach was designed to achieve these aims. Phase 1consisted of a nationwide survey of the extent of checklist use. Phase 2 involved observations and medical record audit to determine compliance with checklist use, and included qualitative discussions with hospital staff to identify barriers and enablers to their use. Phase 3 included the conduct of two formal focus groups (one with radiologists and one with surgeons) to better understand why certain barriers occurred and identify potential areas for improvement.
Results: From the 1039 surveys sent out, 180 surveys were returned (a response rate of 17% in Phase 1). Checklists were in place in 91% of organisations. The majority (60%) were modified, paper checklists,and most respondents had a positive attitude to their use. The most prevalent barrier was ‘time’,whilst ‘nursing staff’, ‘general staff involvement’ and ‘culture/commitment to patient safety’ each rated equally as the highest enablers. Another important point to have come out of Phase 1 of the project is that incongruence exists between the actual usage of the safety checklist by hospitals compared to the WHO standard. This was further examined in Phase 2 of the project.Eleven surgical departments participated in Phase 2. For these, overall average completion of the checklist was 27%. The checklist items most commonly addressed by the surgical staff were: correct patient (99%), site (37%) and procedure (97%), that the consent form has been signed (36%),whether the patient has any allergies (80%), and whether the instrument counts were correct (56%). From discussions with staff, 13 broad categories were identified that related to enabling factors and17 to barriers. Four radiology departments participated in Phase 2. Checklist compliance ranged from 0-100% across the sample, with a mean of 38% completion. Checklist items most commonly addressed included correct patient and procedure (80% and 59%, respectively), and whether or not the patient had any allergies (61%). From discussions with staff, 12 broad categories were identified that related to enabling factors and six to barriers. There was no significant difference between surgery (M = 37, SD = 19) and radiology (M = 38, SD = 31) with respect to their completion of thesafety checklist.
Conclusion: This project is the first national investigation conducted into the use of checklists throughout Australia. Although checklists have been received positively where they have been implemented, the completion of checklists appears to be low in both surgical and radiological settings. A number of barriers and enablers to the use of checklists were identified. There was a substantial gap between what was documented to have been done and what was actually done; this required policy change to ensure they are addressed
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Copyright 2014 The author(s).