Surgery
Safe surgery checklists: final conclusions
Following a series of articles in the February and March editions ofCSJ, on the barriers operating theatre teams face in relation to the WHO Safe Surgery Checklist, Nigel Roberts concludes with a report on a third and final Delphi study round.
This quantitative research paper was the final of three Delphi study rounds that looked to address information raised as part of a wider study on the Surgical Safety Checklist (SSC) across NHS hospital operating theatres in England. The aim of the study, through a combination of open-ended questions, was to solicit specific information, views and to establish from theatre safety experts on how the World Health Organization’s (WHO) SSC is being used and why intraoperative Never Events are still occurring over a decade after the SSC was introduced. The final round was aimed at drawing
together the previous two rounds and offering participants the opportunity to revise their previously recorded judgements. Participants were from the seven regions identified by NHS England. The study revealed that there needs to be an increased emphasis placed on training on the delivery of the checklist, as participants felt that each step of the five was important and that training should be a combination of online, practical and simulation combined with non-technical skills.
While the intention is not to establish whether
the lack of training, engagement and human factors has led to an increased presence of intraoperative Never Events, methodological triangulation with the current known literature will provide an exploratory approach to inform a more in-depth doctoral research study intended to improve safety in the operating theatre, inform policy making and ultimately quality improvement. The paper addresses information raised as part of a research study of NHS hospital operating theatres in England.
Introduction and background context In 2009, the World Health Organization launched guidelines for Safe Surgery Saves Lives (WHO, 2009)1
in six languages (Haynes et al, 2009)2 across 132 countries (Gillespie et al, 2018)3 , with
the aim of preventing unnecessary deaths and improving outcomes for surgical patients (Viswanath et al, 2017).4
Consequently, nineteen
items were compiled into the three steps for the original WHO surgical safety checklist (SSC). However, later in December 2010, following
feedback from the initial implementation, a further two steps were added. These were the team brief and debrief (Shah et al, 2011).5 McConnell et al (2012)6
suggested the checklist
should remain succinct and concise, otherwise checklist fatigue may occur. Harden (2013)7 suggested that checklists are not one-size-fits- all; they must be customised to fit local practice. Raman et al (2016)8
suggested that checklists
need to be tailored to the specific task being performed. The use of stock questions decreases the likelihood of ensuring all theatre personnel are attentive. This quantitative research gathered data to seek the expert viewpoints of users of the WHO checklist, to gain a consensus of opinion based on the end users’ knowledge and expertise. The data collected helped to identify trends and patterns to make logical sense of this research topic. The method used promoted anonymity and avoided direct confrontation among experts. Barrett and Heale (2020)9
state that the
Delphi technique (used for this research) was first developed in the 1950s in an attempt to gain reliable expert consensus. Jones and Hunter (1995), cited in Vogal et al (2019),10 further explained that “this technique seeks the opinion of a group of experts in order to assess the extent of agreement and to resolve disagreement on an issue”. The Delphi technique is an iterative multistage process, designed to transform opinion into group consensus. If used systematically and rigorously, it can contribute significantly to broadening knowledge with the healthcare profession To put this research study into context and
to explain the rationale for why the research is valid, table one highlights the number of surgical intraoperative Never Events that have occurred between April 2012 and August 2022.
Literature review The checklists that are used across the world today are based upon three principles: simplicity, widespread applicability, and measurability
April 2023 I
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