Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1519_Библиотеки_им_академика_М_И_Перельмана.pdf
456
Table 40.2 Question 2: Do surgical checklists offer other benefits?
Author/year Study design n/type of procedure Outcome measures Conclusions
Quality of
evidence
Tillman et al. (2013) [9] Prospective cohort 824/general procedures Compliance with SCIP
measures
Implementation of SSC
improves compliance with
SSI reduction strategies and
may reduce SSI rates in
colorectal procedures
Moderate
Kim et al. (2015) [17] Prospective cohort 637/general procedures Overall complications,
hypoxemia, adherence to
safety processes
SSC implementation at a
resource-limited hospital
improves communication,
adherence to safety processes,
and complications with no
reduction in mortality.
Improvements were greater
after 2 years than after 6
months
Low
Semel et al. (2010) [24] Prospective cohort n/a Cost of SSC
implementation
Theoretical hospital cost of
SSC implementation is
recovered if five major
complications are prevented
Low
McCarroll et al. (2015) [12] Meta-analysis 89/robotic/laparoscopic 30 day readmission
Length of stay Operative
time
Decreased readmissions
(13.5 % vs 4.1 %), no
difference in LOS or OR time
Very low
E.A. Sparks and H.T. Papaconstantinou
www.ebook3000.com
457
cohort studies of 37,339 patients, concluding that SSC’s significantly reduce post-
operative complications [4]. Van Klei et al. reported a significant reduction in mor-
tality when checklists were fully completed [16]. Lastly, in an attempt to remove
confounders, Haugen et al. described an elaborate protocol for SSC implementa-
tion, finding significant reductions in morbidity and length of stay [8]. Collectively,
these studies indicate that implementation of surgical safety checklists likely
improves post-operative outcomes including mortality rates.
However, the benefits above have not been demonstrated in all studies. Several
investigators have suggested necessary conditions under which morbidity and mor-
tality can be reduced. Surgical safety checklists are designed primarily to prevent
deaths from perioperative errors, which are rare events. Therefore, the intervention
of introducing checklists should be with the expectation of population-level bene-
fits, and that a large cohort size will be required to demonstrate effectiveness.
Second, some authors have demonstrated effectiveness by examining higher-risk
populations (e.g., complicated procedures, unplanned procedures, colorectal opera-
tions, and procedures at limited-resource hospitals [3, 5, 9, 10, 12, 15, 17]) or by
studying more common or impactful outcomes (e.g., re-operation, infection rates,
length of stay [5, 9, 10, 12–18]). Safety culture and attitudes may also play a role in
checklists and patient outcome. Haynes et al. updated their original work with a
survey of attitudes toward the SSC and found essentially a dose-response curve in
which changes in outcomes were directly associated with team perceptions of suc-
cessful checklist implementation [23]. Fidelity of checklist use and completion has
been shown to have a direct correlation with reduction in morbidity [16]. Therefore,
the evidence clearly indicates that checklists reduce morbidity and mortality effec-
tively, as long as they are being used as intended.
Question 2: Do surgical checklists have other costs or benefits?
In addition to preventing morbidity and mortality, other indirect measures of
quality have been shown to improve with SSC use (Table 40.2). Standardized peri-
operative processes of care have been shown to improve outcomes. Performance
measures including antibiotic timing, intraoperative hypothermia management, and
hypoxemia have all been shown to improve with checklist implementation [5, 9, 17].
As a further indication of SSC success, implementation has improved perceptions of
perioperative patient safety and communication among operative teams [17, 23].
The vocal critics who oppose the conception of surgical safety checklists have
expressed concerns and negative perceptions in the form of anecdotal evidence,
surveys, and opinion papers. Some believe that use of a checklist in the operating
room is ineffective, unnecessary, and reduces operating room efficiency [25]. Even
though there are studies that have failed to demonstrate effectiveness, the concerns
brought forth by these critics have not been objectively validated and in some cases
directly refuted. Two cohort studies have shown no difference in operative times
before and after SSC implementation [12, 26]. This seems intuitive since the
checklist itself takes only a few minutes. Results from our institution indicate that
SSC implementation did not affect first-start in room on time performance or same
day cancellations [9]. Furthermore, the cost of SSC has been investigated. Semel
40 Checklists in Surgery
458
et al. calculated a cost-savings of $103,829 per year assuming prevention of five
major complications during 4000 non-cardiac operations [24]. Therefore, checklists
have the added benefit of improving performance of standardized care, perception
of patient safety, and communication among team members without adversely
affecting operating room efficiency or cost.
Question 3: Are there costs or barriers to use of surgical checklists?
From the inception of checklist utilization, barriers to their use have been present
(Table 40.3). The most obvious of these is non-use or failure to complete the check-
list [6, 27]. However, “checklist mentality” leads to misuse even after a high com-
pletion rate is achieved. Several investigators have audited checklists and team
behavior, universally finding poor checklist fidelity [16, 37, 39]. This may be a
direct result of checkbox fatigue where the process turns from one of patient safety
and benefit to one of mundane automatic (or mindless) checking of a box.
Many specific barriers have been identified which inhibit a culture of SSC com-
pliance. Ineffective education at the time of implementation may hinder adoption,
while educational interventions are capable of improving compliance [38].
Checklist-specific factors including non-redundancy, inclusion of only critical and
actionable items, and ease of use are described most effectively in Atul Gawande’s
“Checklist for Checklists” [43]. In the end, investigators have almost universally
concluded that leadership buy-in remains the most significant barrier to checklist
use [34, 40, 41].
Fundamentally, one may reasonably assume that outcome improvements cannot
be seen without proper use of the checklist. Frequent audits of checklist use with
cyclical user-feedback and re-education are proposed to help overcome these barri-
ers. Although the barriers to ideal checklist use are numerous, they are well-defined
and can be overcome by a carefully designed and implemented checklist process.
Question 4: Do surgical checklists offer specific benefits to colorectal surgery?
Limited data exist to describe the effects of SSC use specific to the field of
colorectal surgery (Table 40.4). Tillman et al. performed a prospective cohort study
demonstrating improvement in compliance with SCIP SSI-reduction strategies in
general surgery patients. In the subpopulation of 183 patients undergoing colec-
tomy, SCIP compliance increased and SSI’s decreased (24.1 % vs 11.5 %, p = 0.03)
after implementation of a surgical safety checklist [9]. O’Mahoney et al. performed
a retrospective descriptive study using a checklist to evaluate operative steps of
laparoscopic colon resections. They demonstrated feasibility/reproducibility of
this tool to identify and document completion of key surgical steps. The authors
propose that this standardization offers easier implementation of quality improve-
ment projects in colorectal surgery [44]. As such, the benefits of checklist use are
likely applicable beyond those specifically attributed to the well-studied WHO
Surgical Safety Checklist. The place of this tool in the field of colorectal surgery is
discussed in further detail in the “personal view of the data” section of this review.
Since checklists are excellent tools to ensure performance of complex tasks; it is
intuitive that their use in multidisciplinary disease management plans can be power-
ful. Rectal cancer is a wonderful example as multiple diagnostic and treatment steps
E.A. Sparks and H.T. Papaconstantinou
www.ebook3000.com
459
Table 40.3 Question 3: Are there costs or barriers to use of surgical checklists?
Author/year Study design
n/type of
procedure Outcome measures Conclusions
Quality of
evidence
Oak et al. (2015)
[27]
Prospective
case series
3000/
general
Pediatric surgery: major
errors, “near misses”,
checklist compliance
0 major errors, 0.3 % near misses, high rate of incompletion
or errors
Low
Biskup et al.
(2015) [28]
Retrospective
cohort
2166/
plastics
30 days complications Checklist does not reduce complication rates, likely due to
checklist item applicability
Low
Haynes et al.
(2015) [19]
Opinion n/a n/a Checklists are effective if barriers to implementation are
overcome
Very Low
Mahmood et al.
(2015) [29]
Retrospective
case series
51/
general
Checklist compliance Checklist completion overestimates actual practice
compliance.
Low
Johnston et al.
(2004) [30]
Prospective
case series
63/
general
Checklist compliance
(audit)
Audit tool was successful, compliance with checklist
standards varied from 0 to 100 %
Low
Shapiro et al.
(2013) [31]
Opinion n/a n/a Checklists are needed for office-based surgeries Very Low
Abdel-Rehim
et al. (2011) [32]
Retrospective
cohort
90/
general
Checklist compliance Use of the WHO SSC improves perioperative use of surgical
“Time out”
Very Low
Mahaffey et al.
(2010) [25]
Opinion n/a n/a Proper use of a checklist is dificult to maintain; SSC’s are
distracting and ineffective.
Very Low
Panesar et al.
(2009) [22]
Opinion n/a n/a Adoption of SSC is effective and should be adopted
throughout the UK
Very Low
de Vries et al.
(2008) [33]
Opinion n/a n/a Checklists should be empoyed in surgical care beyond the
operative phase
Very Low
Kim et al. (2015)
[17]
Retrospective
cohort
637/
general
Overall complications,
hypoxemia, adherence to
safety processes
SSC implementation at a resource-limited hospital improves
communication, adherence to safety processes, and
complications with no reduction in mortality. Improvements
were greater after 2 years than after 6 months
Low
(continued)
40 Checklists in Surgery
460
Table 40.3 (continued)
Author/year Study design
n/type of
procedure Outcome measures Conclusions
Quality of
evidence
Russ et al. (2015)
[34]
Prospective
case series
874/
general
Compliance with checklist
steps (audit)
SSC is frequently incompletely or inappropriately performed.
Senior leadership performed best and should champion SSC
use
Low
Russ et al. (2015)
[35]
Survey 119/
general
Attitudes towards SSC use checklist characteristics, methods of implementation, senior
staff support, and post-implementation monitoring are
important factors to SSC compliance
Low
Putnam et al.
(2014) [36]
Prospective
cohort
873/
general
Checklist compliance Interventions to improve checklist compliance are effective Low
Papaconstantinou
et al. (2013) [26]
Retrospective
cohort
35,570/
general
OR efficiency Implementation of SSC does not negatively impact OR
efficiency
Moderate
Sparks et al.
(2013) [37]
Retrospective
cohort
671/
general
Checklist compliance Accuracy of checklist completion remains poor after high
participation and completion rates are achieved
Low
Sheena et al.
(2012) [38]
Prospective
cohort
72/ENT checklist compliance Educational intervention improves checklist compliance Moderate
Levy et al.
(2012) [39]
Prospective
cohort
142/
general
Checklist fidelity Despite 100 % documentation, process compliance is poorer
(60–97 %).
Moderate
Conley et al.
(2011) [40]
Survey n/a Preceptions of barriers to
SSC implementation
SSC success is related to effectiveness of implementation
which hinges on buy-in of leadership
Low
Vats et al. (2010)
[41]
Opinion n/a n/a SSC use is frequently poor. Barriers to effective SSC
implementation include insufficient education, lack of
leadership buy-in, perceived inefficiency, and duplicated
steps.
Low
Terry et al.
(2009) [42]
Opinion n/a n/a Acceptance and implementation of SSC’s is spreading, yet
physician resistance remains frequent
Very Low
Haynes et al.
(2011) [23]
Survey 281/
general
Attitudes towards SSC use Reduction in complications is directly associated with
attidues towards SSC use
Low
E.A. Sparks and H.T. Papaconstantinou
www.ebook3000.com
461
exist, treating team members are interdependent on each other, and multidisci-
plinary input and communication is crucial to optimal outcomes.
Recommendations from the Data
1. Implementation of surgical safety checklists likely improves post-operative out-
comes including mortality rates (Level 2a). Outcomes at highest risk are the
most likely to see these benefits (Level 2b). Success hinges on achieving high
rates of participation and proper checklist use (Level 2b).
2. Surgical safety checklists do not increase operative times and are not hindrances
to the operative team (Level 2b). These tools likely improve efficiency, multidis-
ciplinary communication, and compliance with universal quality improvement
initiatives in addition to reducing surgical errors (Level 2b).
3. There are a host of physical and cultural barriers to checklist implementation
(Level 2b). These barriers may be overcome by cyclical auditing of checklist use,
feedback, and re-education (Level 2b).
4. Surgical safety checklists may offer specific benefits when applied to colorectal
surgery (Level 2b). Checklists will likely play a broader role as an invaluable
tool for quality improvement in surgery and ensuring proper delivery of care by
complex multidisciplinary teams (Level 5).
Personal View of the Data
Surgical care is becoming more and more complicated. As humans, our memory is
fallible especially in stressful and complex situations. This is clearly true in surgical
patients, and recent efforts to optimize outcomes have become more focused on
Table 40.4 Question 4: Do surgical checklists offer specific benefits to colorectal surgery?
Author/year Study design
n/type of
procedure
Outcome
measures Conclusions
Quality of
evidence
Tillman
et al. (2013)
[9]
Prospective
cohort
824/general
procedures
Compliance
with SCIP
Measures
Implementation of
SSC improves
compliance with
SSI reduction
strategies and may
reduce SSI rates in
colorectal
procedures
Moderate
O’Mahoney
et al. (2015)
[44]
Retrospective
cohort
16/colorectal
procedures
Compliance
with
operative
steps
Checklists help
definite and
document key steps
of laparoscopic
surgery
Low
40 Checklists in Surgery
462
standardization of care. Surgical checklists have proven to be an invaluable tool for
standardizing the processes of care and improving performance on quality mea-
sures. They accomplish this directly, by ensuring that specific tasks are accom-
plished, and indirectly, by improving communication among multidisciplinary
teams. Through these effects, checklists clearly have the ability to reduce morbidity
and mortality and improve outcomes.
The checklist, however, does not accomplish these goals by itself; it is not a
magic carpet. Human factors affect adoption and effective use, and incorporate the
patient safety culture, ownership of process, and team member buy-in. In fact,
despite the seemingly simple nature of a checklist, potential pitfalls are numerous.
We have found both anecdotally and based on literature review that the following
steps are crucial for successful checklist implementation and use.
1. Multidisciplinary planned approach to checklist design and content. You must
get buy-in from all stake holders and participants. This will enhance enthusiasm,
performance and successful adoption of the checklist.
2. Development of a checklist which meets the recommendations of “Checklist for
Checklists” Gawande’s “Checklist for Checklists”. The first and perhaps most
important step here is determining that each checklist item is “a critical safety
step and in great danger of being missed”, “not adequately checked by other
mechanisms”, “actionable, with a specific response required”, and “can be
affected by the use of a checklist”. Our opinion is that many checklists which
suffer from checkbox fatigue and poor fidelity, if examined, will fail to meet
many of these requirements.
3. Leadership must “walk the walk and talk the talk”. Physician champions and
leaders must embrace and perform the checklist in the proper fashion. Team
members look to their leader to see how they respond and perform. A highly vis-
ible leader that is perceived as cutting corners or not embracing the checklist and
process severely erodes the acceptance, adoption and performance by the
remainder of the team.
4. Extensive team education and simulation prior to use. Successful adoption of
checklists requires explaining why something is being done, and must be fol-
lowed by showing how it is performed. We have found that simulation is the easi-
est way to show the how and allows for direct and immediate feedback on
performance.
5. Carefully planned and staged implementation strategy. After thorough education
and simulation, the implementation phase is another opportunity to avoid check-
list failure. At our institution, checklists were rolled out in select operating rooms
to gather early feedback prior to making system-wide changes. This controlled
approach appeared to ease cultural adoption of the new procedures.
6. Frequent auditing of checklist participation and fidelity. You get what you
inspect, not what you expect. Regular auditing is vital to sustainability of prac-
tice. Auditing should be active, not passive, with direct feedback to the team on
performance and how to improve. If team members are cutting corners or not
performing the checklist as intended, and this is not pointed out and addressed,
E.A. Sparks and H.T. Papaconstantinou
www.ebook3000.com
463
it will be perceived as the way it should be done. This concept of “normalization
of deviance” is likely why many institutions, including our own, have seen per-
formance erode over time after implementation. Feedback of compliance and
outcomes should be shared with the team and augmented with continuing educa-
tion. Celebration of successes is important to improve morale, justify continued
use, and create a positive culture of safety.
7. Iterations of steps 1–6 to continuously improve the checklist and enhance the
involved processes. Checklists need an appropriate balance of flexibility and
rigidity. For flexibility, we consider this adaptation to an ever changing environ-
ment, needs, and evidence of benefit. We believe that checklist change must be a
structured process and requires a formal request for change with appropriate data
to support the change. This is evaluated by physician champions and team lead-
ers with rapid feedback regarding decision with supporting information. The
rigidity is in maintaining the integrity and focus of the checklist. Wide deviations
can erode into the spirit and intent of the checklist eliminating support for “why”
it is being done.
Of all these steps, we have found that investment, support, and exemplary par-
ticipation and performance of physician champions from all teams appear to be the
most critical and most frequently missed step. This chapter focuses significantly on
the surgical safety checklist; however, we believe that checklists play a broader role
for colon and rectal surgeons. Checklists allow standardization of care and data col-
lection for research and quality improvement. Opportunities are present for design
of new checklist tools which help bridge the gaps between scientifically supported
“best practice” and what is actually provided in routine care.
One potential application is the Rectal Cancer Centers of Excellence initiative.
Checklists are perfect for this situation as they provide a strict protocol for guidance
and objective performance data to tie to outcomes. Our goal in this chapter has been
to provide a better understanding of the successes and pitfalls of checklists so that
colon and rectal surgeons become champions of theses quality improvement initia-
tives and consider them a new tool which helps reduce variability in care and pro-
vides an opportunity to improve outcomes.
References
1. Institute of Medicine Committee on Quality of Health Care in America, in Kohn LT, Corrigan
JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC):
National Academies Press (US); 2000. Copyright 2000 by the National Academy of Sciences.
All rights reserved.
2. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and
mortality in a global population. N Engl J Med. 2009;360:491–9.
3. Sewell M, Adebibe M, Jayakumar P, et al. Use of the WHO surgical safety checklist in trauma
and orthopaedic patients. Int Orthop. 2011;35:897–901.
4. Gillespie BM, Chaboyer W, Thalib L, et al. Effect of using a safety checklist on patient complica-
tions after surgery: a systematic review and meta-analysis. Anesthesiology. 2014;120:1380–9.
40 Checklists in Surgery
464
5. Kwok AC, Funk LM, Baltaga R, et al. Implementation of the World Health Organization surgi-
cal safety checklist, including introduction of pulse oximetry, in a resource-limited setting.
Ann Surg. 2013;257:633–9.
6. Bliss LA, Ross-Richardson CB, Sanzari LJ, et al. Thirty-day outcomes support implementa-
tion of a surgical safety checklist. J Am Coll Surg. 2012;215:766–76.
7. Weiser TG, Haynes AB, Dziekan G, et al. Effect of a 19-item surgical safety checklist during
urgent operations in a global patient population. Ann Surg. 2010;251:976–80.
8. Haugen AS, Softeland E, Almeland SK, et al. Effect of the World Health Organization check-
list on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg.
2015;261:821–8.
9. Tillman M, Wehbe-Janek H, Hodges B, et al. Surgical care improvement project and surgical
site infections: can integration in the surgical safety checklist improve quality performance and
clinical outcomes? J Surg Res. 2013;184:150–6.
10. Askarian M, Kouchak F, Palenik CJ. Effect of surgical safety checklists on postoperative mor-
bidity and mortality rates, Shiraz, Faghihy Hospital, a 1-year study. Qual Manag Health Care.
2011;20:293–7.
11. Yuan CT, Walsh D, Tomarken JL, et al. Incorporating the World Health Organization Surgical
Safety Checklist into practice at two hospitals in Liberia. Jt Comm J Qual Patient Saf.
2012;38:254–60.
12. McCarroll ML, Zullo MD, Dante Roulette G, et al. Development and implementation results
of an interactive computerized surgical checklist for robotic-assisted gynecologic surgery.
J Robotic Surg. 2015;9:11–8.
13. Garcia-Paris J, Cohena-Jimenez M, Montano-Jimenez P, Cordoba-Fernandez
A. Implementation of the WHO “Safe Surgery Saves Lives” checklist in a podiatric surgery
unit in Spain: a single-center retrospective observational study. Patient Saf Surg. 2015;9:29.
14. Reames BN, Krell RW, Campbell Jr DA, Dimick JB. A checklist-based intervention to improve
surgical outcomes in Michigan: evaluation of the Keystone Surgery program. JAMA Surg.
2015;150:208–15.
15. Loor G, Vivacqua A, Sabik 3rd JF, et al. Process improvement in cardiac surgery: development
and implementation of a reoperation for bleeding checklist. J Thorac Cardiovasc Surg.
2013;146:1028–32.
16. van Klei WA, Hoff RG, van Aarnhem EE, et al. Effects of the introduction of the WHO
“Surgical Safety Checklist” on in-hospital mortality: a cohort study. Ann Surg. 2012;255:44–9.
17. Kim RY, Kwakye G, Kwok AC, et al. Sustainability and long-term effectiveness of the WHO
surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year
update from Moldova. JAMA Surg. 2015;150:473–9.
18. Dell’Atti L. Introduction of a checklist to reduce adverse events in urologic surgery: our expe-
rience. Urologia. 2013;80:239–43.
19. Haynes AB, Berry WR, Gawande AA. What do we know about the safe surgery checklist
now? Ann Surg. 2015;261:829–30.
20. Garg T, Bazzi WM, Silberstein JL, et al. Improving safety in robotic surgery: intraoperative
crisis checklist. J Surg Oncol. 2013;108:139–40.
21. Ladak A, Spinner RJ. Redefining “wrong site surgery” and refining the surgical pause and
checklist: taking surgical safety to another level. World Neurosurg. 2014;81:e33–5.
22. Panesar SS, Cleary K, Sheikh A, Donaldson L. The WHO checklist: a global tool to prevent
errors in surgery. Patient Saf Surg. 2009;3:9.
23. Haynes AB, Weiser TG, Berry WR, et al. Changes in safety attitude and relationship to
decreased postoperative morbidity and mortality following implementation of a checklist-
based surgical safety intervention. BMJ Qual Saf. 2011;20:102–7.
24. Semel ME, Resch S, Haynes AB, et al. Adopting a surgical safety checklist could save money
and improve the quality of care in U.S. hospitals. Health Aff (Project Hope).
2010;29:1593–9.
25. Mahaffey PJ. Checklist culture. Seductions of the WHO safe surgery checklist. BMJ (Clinical
research ed). 2010;340:c915.
E.A. Sparks and H.T. Papaconstantinou
www.ebook3000.com
465
26. Papaconstantinou HT, Smythe WR, Reznik SI, et al. Surgical safety checklist and operating
room efficiency: results from a large multispecialty tertiary care hospital. Am J Surg.
2013;206:853–9. discussion 859–860.
27. Oak SN, Dave NM, Garasia MB, Parelkar SV. Surgical checklist application and its impact on
patient safety in pediatric surgery. J Postgrad Med. 2015;61:92–4.
28. Biskup N, Workman AD, Kutzner E, et al. Perioperative safety in plastic surgery: is the world
health organization checklist useful in a broad practice? Ann Plast Surg. 2016;76:550–5.
29. Mohammed A, Wu J, Biggs T, et al. Does use of a World Health Organization obstetric safe
surgery checklist improve communication between obstetricians and anaesthetists? A retro-
spective study of 389 caesarean sections. BJOG. 2013;120:644–8.
30. Johnston FM, Tergas AI, Bennett JL, et al. Measuring briefing and checklist compliance in
surgery: a tool for quality improvement. Am J Med Qual. 2014;29:491–8.
31. Shapiro FE, Punwani N, Urman RD. Checklist implementation for office-based surgery: a
team effort. AORN J. 2013;98:305–9.
32. Abdel-Rehim S, Morritt A, Perks G. WHO surgical checklist and its practical application in
plastic surgery. Plastic Surg Int. 2011;2011:579579.
33. de Vries EN, Boermeester MA, Gouma DJ. WHO’s checklist for surgery: don’t confine it to
the operating room. Lancet (London, England). 2008;372:1148–9.
34. Russ S, Rout S, Caris J, et al. Measuring variation in use of the WHO surgical safety checklist
in the operating room: a multicenter prospective cross-sectional study. J Am Coll Surg.
2015;220:1–11.e14.
35. Russ SJ, Sevdalis N, Moorthy K, et al. A qualitative evaluation of the barriers and facilitators
toward implementation of the WHO surgical safety checklist across hospitals in England: les-
sons from the “Surgical Checklist Implementation Project”. Ann Surg. 2015;261:81–91.
36. Putnam LR, Levy SM, Sajid M, et al. Multifaceted interventions improve adherence to the
surgical checklist. Surgery. 2014;156:336–44.
37. Sparks EA, Wehbe-Janek H, Johnson RL, et al. Surgical Safety Checklist compliance: a job
done poorly! J Am Coll Surg. 2013;217:867–73.e861–3.
38. Sheena Y, Fishman JM, Nortcliff C, et al. Achieving flying colours in surgical safety: audit of
World Health Organization ‘Surgical Safety Checklist’ compliance. J Laryngol Otol.
2012;126:1049–55.
39. Levy SM, Senter CE, Hawkins RB, et al. Implementing a surgical checklist: more than check-
ing a box. Surgery. 2012;152:331–6.
40. Conley DM, Singer SJ, Edmondson L, et al. Effective surgical safety checklist implementa-
tion. J Am Coll Surg. 2011;212:873–9.
41. Vats A, Vincent CA, Nagpal K, et al. Practical challenges of introducing WHO surgical check-
list: UK pilot experience. BMJ (Clinical research ed). 2010;340:b5433.
42. Terry K. Patient safety. Push for hospitals to use surgical checklist getting results. Hosp Health
Netw 2009;83:12, 14.
43. “Checklist for Checklists.” Project Check. Web. 30 July 2016. <http://www.projectcheck.org/
checklist-for-checklists.html>.
44. O’Mahoney PR, Trencheva K, Zhuo C, et al. Systematic video documentation in laparoscopic
colon surgery using a checklist: a feasibility and compliance pilot study. J Laparoendosc Adv
Surg Tech A. 2015;25:737–43.
40 Checklists in Surgery