A Simplified WHO Checklist Improves Compliance and Time Efficiency for Urological Surgery

Abstract

Objective:

A surgical safety checklist has been introduced throughout the UK in response to evidence that its use decreases surgical morbidity and mortality. The adaptation of this has resulted in a lengthy checklist which may be used improperly. We audited the existing and a new simplified checklist with regards to compliance, time-efficiency and relevant safety outcomes.

Materials and methods:

One hundred operations were observed. Fifty of these cases used the existing 14-question Briefing/Debriefing (BD) and 31-question Sign-in, Timeout and Sign-Out (STS) checklist. The subsequent 50 used a simplified 10-question BD and STS checklist. Percentage compliance, median time taken and relevant safety outcomes were recorded.

Results:

The median time for the BD questions decreased from 150 to 90s and the STS questions from 88 to 49s (p<0.05). The compliance improved from 68% to 73% (p= 0.49) for BD questions and 53% to 92% (p< 0.05) for STS questions. A clearer phrasing of the antibiotic check question in the revised checklist resulted in no administration of incorrect antibiotics.

Conclusion:

The nuclear and airline industries have used checklists for many years and observed that long and exhaustive checklists were often used improperly or disregarded completely. We demonstrate that a redesigned, simplified checklist improves time-efficiency and compliance with improved safety outcomes.