Adoption and Implementation of the Surgical Safety Checklist: Improving Safety in an Italian Teaching Hospital

Utilization and Completeness of Surgical Safety Checklist with Associated Factors in Surgical Units of Jimma University Medical Center, Ethiopia

Introduction

Surgical safety checklist is used for every patient undergoing a surgical procedure and is now employed by a majority of surgical providers around the world, but the utilization and completion of surgical safety checklists were low in lower- and middle-income countries.

Objective

The objective of this study was to evaluate the utilization and completeness of the surgical safety checklist in surgical units of Jimma University Medical Center, Ethiopia.

Methods

Hospital-based prospective cross-sectional study was conducted from October 1 to 30, 2020. A total of 384 surgical cases were included in the study. Checklists were kept as part of each patient's medical record, and consecutive post-operative patient charts were included in the study. The data were collected using the modified version of the WHO checklist constituted of 27 items. The collected data were cleaned, coded, and entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Binary and multiple logistic regression analyses were computed, and the level of statistical significance was determined at p < 0.05.

Results

The use of a surgical safety checklist was 93.5%. The checklist was completed 17.3% of the time, with sign-in, time-out, and sign-out being completed 83%, 25%, and 35% of the time, respectively. Utilization of the surgical safety checklist was 87.4%, which is lower in elective surgeries (AOR = 0.126 95% CI (0.039-0.414)) compared with the emergency procedure. Once more, the completeness of the safety checklist was 63.3%, which is lower in elective surgery (AOR = 0.367 95% CI (0.208-0.65)) than in emergency procedures.

Conclusion

The use of a surgical safety checklist was promising, while the completeness of the checklist was poor that demands further improvement. Time-out was the least completed section of the checklist. Completion of the checklist was high in the first case on the positions of the theatre list.

Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor–patient alliance.