Narrative feedback from OR personnel about the safety of their surgical practice before and after a surgical safety checklist intervention

Abstract

Objective: To examine narrative feedback to understand surgical team perceptions about surgical safety checklists (SSCs) and their impact on the safety of surgical practice.

Design: We reviewed free-text comments from surveys administered before and after SSC implementation between 2011 and 2013. We categorized feedback thematically and as positive, negative or neutral.

Setting: South Carolina hospitals participating in a statewide collaborative on checklist implementation.

Participants: Surgical teams from 11 hospitals offering free-text comments in both pre-and post-implementation surveys.

Intervention: Implementation of the World Health Organization SSC.

Main outcome measure: Differences in comments made before and after implementation and by provider role; types of complications averted through checklist use.

Results: Before SSC implementation, the proportion of positive comments among provider roles differed significantly (P = 0.04), with more clinicians offering negative comments (87.9%, (29/33)) compared to other surgical team members (58.3% (7/12) to 60.9% (14/23)), after SSC implementation, these proportions did not significantly differ (clinicians 77.8% (14/18)), other surgical team members (50% (2/4) to 76.9% (20/26)) (P = 0.52). Distribution of negative comments differed significantly before and after implementation (P = 0.01); for example, there were more negative comments made about checklist buy-in after implementation (51.3 % (20/39)) compared to before implementation (24.5% (13/53)). Surgical team members most frequently reported that checklist use averted complications involving antibiotic administration, equipment and side/site of surgery.

Conclusions: Narrative feedback suggested that SSC implementation can facilitate patient safety by averting complications; however, buy-in is a persistent challenge. Presenting information on the impact of the SSC on lives saved, teamwork and complications averted, adapting the SSC to fit the local context, demonstrating leadership support and engaging champions to promote checklist use and address concerns could improve checklist adoption and efficacy.

Keywords: implementation; narrative feedback; open-ended survey questions; patient safety; surgery; surgical safety checklist.