Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out
Introduction & aim Intraoperative adverse events (iAEs) increase postoperative complications, which are devastating to patients and costly to healthcare systems. To optimise patient outcomes, the WHO Surgical Safety Checklist (WHO SSC) was introduced in 2008, but adherence, especially to its...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-05-01
|
| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/2/e003286.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849689561034129408 |
|---|---|
| author | Guy Haller Lauren Clack Christian Schindler Luzius A Steiner Salome Dell-Kuster Dieter Hahnloser Jörn-Markus Gass Christoph S Burkhart Andreas P Vogt Katrin Burri-Winkler Anne C Auderset Valentin Neuhaus Giorgio Prouse Judith Winkens Amanda Van Vegten Zuzanna Kita Monika Finsterwald Nico Streit Lisa M Willms |
| author_facet | Guy Haller Lauren Clack Christian Schindler Luzius A Steiner Salome Dell-Kuster Dieter Hahnloser Jörn-Markus Gass Christoph S Burkhart Andreas P Vogt Katrin Burri-Winkler Anne C Auderset Valentin Neuhaus Giorgio Prouse Judith Winkens Amanda Van Vegten Zuzanna Kita Monika Finsterwald Nico Streit Lisa M Willms |
| author_sort | Guy Haller |
| collection | DOAJ |
| description | Introduction & aim Intraoperative adverse events (iAEs) increase postoperative complications, which are devastating to patients and costly to healthcare systems. To optimise patient outcomes, the WHO Surgical Safety Checklist (WHO SSC) was introduced in 2008, but adherence, especially to its third part (sign-out), is low, and iAEs are currently not routinely assessed. This gap between evidence supporting the use of the WHO SSC, current inconsistent sign-out practice and the lack of standardised reporting of iAEs warrants applying an implementation science approach. Hence, this project aims to simultaneously evaluate the effectiveness and implementation of the sign-out, including systematic recording and discussion of iAEs during the sign-out.Methods & analysis Using a hybrid effectiveness-implementation approach, this prospective before-and-after-cohort project includes five surgical disciplines within nine Swiss hospitals. Following an extensive context analysis, this project is set up in three phases: (1) recruitment of 40 patients per surgical discipline and site (approx. 900 in total) for baseline assessment; (2) implementation based on a multifaceted, tailored implementation strategy (including formation of implementation teams, comprehensive education of healthcare professionals, top-down leadership, regular feedback rounds and tailoring implementation to local needs); and (3) recruitment of 40 patients per discipline to assess the changes after implementation (approx. 900). Implementation (eg, checklist fidelity composed of completion and quality) and effectiveness outcomes (ie, clinical patient outcomes) will be analysed using a mixed regression model.Discussion & conclusion By enhancing adherence to the WHO SSC sign-out, including standardised reporting of iAEs, we expect to further improve perioperative patient outcomes. Based on the context analysis, we will provide a widely applicable implementation plan to support and sustain the required behavioural change, which will support roll-out in further hospitals. Meanwhile, clinical and implementation science expertise is meeting the challenges of the complex environment of perioperative care. |
| format | Article |
| id | doaj-art-c4680eab984d4f42b9c3f39fd8af2b5a |
| institution | DOAJ |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-c4680eab984d4f42b9c3f39fd8af2b5a2025-08-20T03:21:34ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-05-0114210.1136/bmjoq-2024-003286Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-outGuy Haller0Lauren Clack1Christian Schindler2Luzius A Steiner3Salome Dell-Kuster4Dieter Hahnloser5Jörn-Markus Gass6Christoph S Burkhart7Andreas P Vogt8Katrin Burri-Winkler9Anne C Auderset10Valentin Neuhaus11Giorgio Prouse12Judith Winkens13Amanda Van Vegten14Zuzanna Kita15Monika Finsterwald16Nico Streit17Lisa M Willms18Department of Anaesthesiology, Geneva University Hospital Main Building, Geneve, SwitzerlandInstitute for Implementation Science in Health Care, University of Zurich, Zurich, SwitzerlandSwiss Tropical and Public Health Institute, Allschwil, SwitzerlandClinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, SwitzerlandClinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, SwitzerlandDepartment of Visceral Surgery, Lausanne University Hospital, Lausanne, SwitzerlandDepartment of Visceral Surgery, Cantonal Hospital Lucerne, Luzern, SwitzerlandDepartment of Anaesthesiology, Emergency Medicine, ICU and Rescue Medicine, Cantonal Hospital Graubünden, Chur, SwitzerlandDepartment of Anaesthesiology and Pain Medicine, Inselspital University Hospital Bern, Bern, SwitzerlandClinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, SwitzerlandClinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, SwitzerlandDepartment of Traumatology, University Hospital Zurich, Zurich, SwitzerlandDepartment of Vascular Surgery and Angiology, Lugano Regional Hospital, Lugano, SwitzerlandPatient Safety, Chief Medical Office, Lindenhof Gruppe, Bern, SwitzerlandQuality Management and Patient Safety, University Hospital Zurich, Zurich, SwitzerlandQuality Management and Patient Safety, University Hospital Zurich, Zurich, SwitzerlandInstitute for Implementation Science in Health Care, University of Zurich, Zurich, SwitzerlandClinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, SwitzerlandClinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, SwitzerlandIntroduction & aim Intraoperative adverse events (iAEs) increase postoperative complications, which are devastating to patients and costly to healthcare systems. To optimise patient outcomes, the WHO Surgical Safety Checklist (WHO SSC) was introduced in 2008, but adherence, especially to its third part (sign-out), is low, and iAEs are currently not routinely assessed. This gap between evidence supporting the use of the WHO SSC, current inconsistent sign-out practice and the lack of standardised reporting of iAEs warrants applying an implementation science approach. Hence, this project aims to simultaneously evaluate the effectiveness and implementation of the sign-out, including systematic recording and discussion of iAEs during the sign-out.Methods & analysis Using a hybrid effectiveness-implementation approach, this prospective before-and-after-cohort project includes five surgical disciplines within nine Swiss hospitals. Following an extensive context analysis, this project is set up in three phases: (1) recruitment of 40 patients per surgical discipline and site (approx. 900 in total) for baseline assessment; (2) implementation based on a multifaceted, tailored implementation strategy (including formation of implementation teams, comprehensive education of healthcare professionals, top-down leadership, regular feedback rounds and tailoring implementation to local needs); and (3) recruitment of 40 patients per discipline to assess the changes after implementation (approx. 900). Implementation (eg, checklist fidelity composed of completion and quality) and effectiveness outcomes (ie, clinical patient outcomes) will be analysed using a mixed regression model.Discussion & conclusion By enhancing adherence to the WHO SSC sign-out, including standardised reporting of iAEs, we expect to further improve perioperative patient outcomes. Based on the context analysis, we will provide a widely applicable implementation plan to support and sustain the required behavioural change, which will support roll-out in further hospitals. Meanwhile, clinical and implementation science expertise is meeting the challenges of the complex environment of perioperative care.https://bmjopenquality.bmj.com/content/14/2/e003286.full |
| spellingShingle | Guy Haller Lauren Clack Christian Schindler Luzius A Steiner Salome Dell-Kuster Dieter Hahnloser Jörn-Markus Gass Christoph S Burkhart Andreas P Vogt Katrin Burri-Winkler Anne C Auderset Valentin Neuhaus Giorgio Prouse Judith Winkens Amanda Van Vegten Zuzanna Kita Monika Finsterwald Nico Streit Lisa M Willms Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out BMJ Open Quality |
| title | Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out |
| title_full | Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out |
| title_fullStr | Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out |
| title_full_unstemmed | Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out |
| title_short | Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out |
| title_sort | protocol for implementation of intraoperative adverse event recording during who checklist sign out |
| url | https://bmjopenquality.bmj.com/content/14/2/e003286.full |
| work_keys_str_mv | AT guyhaller protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT laurenclack protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT christianschindler protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT luziusasteiner protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT salomedellkuster protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT dieterhahnloser protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT jornmarkusgass protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT christophsburkhart protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT andreaspvogt protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT katrinburriwinkler protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT annecauderset protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT valentinneuhaus protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT giorgioprouse protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT judithwinkens protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT amandavanvegten protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT zuzannakita protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT monikafinsterwald protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT nicostreit protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout AT lisamwillms protocolforimplementationofintraoperativeadverseeventrecordingduringwhochecklistsignout |