Use this table to quickly find a mentor for the Surgical Safety Checklist with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.
Avera Heart Hospital of South Dakota - Sioux Falls, SD
Availability Status: Available to answer requests
Licensed Beds: 55
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: October 2008
Mentor Contact Name: Sandy King, RN, BSN, Director of Surgery
Mentor Contact Email: sandy.king@medcath.com
Mentor Contact Phone: 605-977-7092
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist?
A universal understanding among perioperative staff of the importance of patient safety and that each member is responsible for providing a safe surgical experience to our patients has resulted in more meaningful dialogues regarding O.R. processes at our staff meetings. I think creating a more open culture of patient safety among the staff has been so important and created a unanimous buy-in amongst the staff.
What lessons have you learned as you've been testing/implementing the Checklist?
We used the checklist in October 2008 for the first time and it has had several tweaks since then as our circulators think of additional items that should be included or modifications that would allow it to flow better. The list is continually evolving to meet the needs of our patients. Some processes (e.g., blood in the room) that were once in place have been re-examined and re-tooled to provide further safety. The O.R. staff play an active role in determining what should be on the checklist and what does not specifically apply to our daily practice.
We are a cardiovascular hospital with only 3 ORs. Due to our size – and because we are lucky to have 5 CV surgeons who are engaged and who do 99.5% of the surgeries in our ORs – it is usually a fairly straightforward process to go from trial to full implementation.
The Avera Heart Hospital of South Dakota has a very unique patient model that is especially complementary to eliminating waste and variation, creating a culture of safety, and exceeding our patients’ expectations.
How long was your initial test period for the Checklist?
We did not really have an "initial test period." We made some modifications to the WHO Checklist, customizing it to our cardiovascular patients and presented to our O.R. circulators. Buy-in was pretty immediate; all agreed to its importance.
Has your organization moved to broader implementation?
The Checklist remains a work in progress. It is understood that this list will probably be "tweaked" some and that it is not set in stone. Suggestions from staff regarding additions or deletions are determined by group consensus.
If so, when did you start broader implementation of the Checklist?
Implementation started 11-4-08
How many ORs do you have in your organization? 3
How many ORs are currently using the Checklist? 3 - All surgical patients have a checklist
What specialties are currently using the Checklist? Cardiovascular/Cardiothoracic
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist?
The expectation is that all surgical procedures performed have a checklist --- emergency cases would certainly be exempt.
[03/16/09]
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Baylor Regional Medical Center at Plano - Plano, TX
Availability Status: Available to answer requests
Licensed Beds: 120
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: January 2009
Mentor Contact Name: Marty Murff RN, MS
Mentor Contact Email: marty.murff@baylorhealth.edu
Mentor Contact Phone: 469-814-5251
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist? What were the changes in existing processes your organization had to make in order for the Checklist to become part of the routine?
We took the WHO checklist and revised the format and adjusted the content to accommodate covering the steps needed. We also included steps to cover other quality processes we have implemented along with Joint Commission requirements for Universal Protocol/Time Out. One key goal was to ensure we did not increase the number of forms currently being utilized by the circulating nurse. We also ensured the questions could be answered in checklist format as much as possible. The primary changes made included expanding our time-out process to include the necessary components from the WHO Surgical Safety Checklist and formalizing the sign in phase, the team introductions, and the sign out steps.
How did you roll out the Checklist? Did you test it in one OR, a few, or all to start?
Our roll out started with recruiting physician champions. We engaged our high volume surgeons, educated them on the process, emphasized patient safety and made the correlation of boarding an airplane and expecting the check list to be completed by the pilot before take off. We frequently reminded all parties that the focus is on patient safety and not the convenience of anyone in the OR. We started a two-day test with five of our champions. We took their feedback, along with that of the OR staff members, modified our list and prepared to roll it out to all ORs.
What lessons have you learned as you've been testing/implementing the Checklist?
Administrative and physician champion support are key to implementing a successful roll out. Also, zero tolerance for not participating for all involved parties. The message has to be consistent and without exceptions. Everyone in the OR has the authority to “stop the line” if a team member is reluctant to participate and this has the full backing of hospital leaders.
Anecdotally, by using the checklist, staff members have identified situations such as the need to bring additional equipment into the OR prior to beginning surgery, thus avoiding delays or problems.
Has your organization moved to broader implementation?
Yes. Based on our initial test experiences, revisions were made to the checklist and process immediately. On February 9, 2009, we fully implemented the checklist in all rooms for all cases. We were able to implement the checklist with all surgeons in all cases within 2 weeks after the initial test period.
Additionally, our hospital was the pilot hospital for our health care system (Baylor). Our system has a total of 13 hospitals, 11 of which perform operative services. Baylor’s goal was to have all facilities utilizing the checklist by April 6, 2009 in all operating rooms, including labor and delivery operative suites.
How many ORs do you have in your organization?
Baylor Regional Medical Center at Plano has 12 operating rooms.
How many ORs are currently using the checklist?
The Checklist is being used in all 12 ORs.
What specialties are currently using the Checklist?
Ortho, Neuro, General, Bariatric, Gynecology, Ophthalmology, ENT, Oncology, Plastics, Urology, Podiatry and Colon/Rectal
Approximately what percent of your organization’s surgical procedures have been performed while using the Checklist?
Since implementation we have 100% utilization of the checklist for all specialties in all operating rooms, including in emergent cases.
[07/21/09]
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Brigham and Women’s Hospital - Boston, MA
Availability Status: Available to answer requests
Licensed Beds: 720
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2008
Mentor Contact Name:
Main contact: Kristin Styer, RN, Quality Program Manager, Perioperative Nursing
Specialists: Stanley Ashley, MD, general surgeon, Vice Chairman of Department of Surgery & Sunil Eappen, MD, staff anesthesiologist, Vice Chairman for Clinical Affairs
Mentor Contact Email: kstyer@partners.org; sashley@partners.org; seappen@partners.org
Mentor Contact Phone: 617-525-8941
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist?
The key change we made was to enlist clinical leadership for each of the three disciplines involved. One member of the department of surgery, department of anesthesiology, and department of nursing work as partners in this effort, to ensure standardized communication, education, and practice for all disciplines for the Checklist.
We have continued to provide on-site support to each of the rooms using the checklist for the first time and follow up as necessary. We have large, laminated posters of the Checklist in each OR to help the team read each element out loud (the Time Out section is enlarged more as the surgeon is designated to lead that section).
How did you roll out the Checklist?
We piloted the checklist in one general surgery OR and one cardiac surgery OR on November 3, 2008. From there, we spread to a total of 8 general surgeons, 1 GYN surgeon, and one cardiac surgeon.
What lessons have you learned as you've been testing/implementing the Checklist?
It is crucial to have endorsement and support from top leadership and the structure to support the roll out of the Checklist, which should include one leader from each discipline. Equally important is the communication plan, so that each discipline is hearing the same, timely information and receiving appropriate education on how to use the Checklist.
We take one day at a time and learn from the end-users how to make the Checklist a part of the normal part of practice. Feedback has been instrumental; we have made several changes to the Checklist (either content or aesthetics) based on this. Having resources in the room to observe, guide, and support has been a great help to witness the Checklist being used and elicit real-time feedback.
How long was your initial test period for the Checklist? Two weeks.
Has your organization moved to broader implementation? Yes
If so, when did you start broader implementation of the Checklist?
We began a staggered roll out to all of our main operating rooms on March 30, 2009. We are in the process of organizing roll out to L & D operating rooms as well as several out of OR areas (radiology, angio, etc).
How many ORs do you have in your organization? 41 main ORs; 5 L & D ORs
How many ORs are currently using the Checklist? 19 ORs, spreading every week to reach all 41 by May 26, 2009.
What specialties are currently using the Checklist?
General, Surgical Oncology, Burn/Trauma, Genitourinary, and Orthopedics (with GYN, thoracics, cardiac, ENT, vascular, plastics, neurosurgery services to follow)
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist?
General, GU, orthopedics, and Surg Onc/BMT services are responsible for 46% of the surgical cases and are currently using the Checklist in all of their cases.
[04/13/09]
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Coney Island Hospital - Brooklyn, NY
Availability Status: Available to answer requests
Licensed Beds: 371
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: July 2008
Mentor Contact Name: Sabina Zak, RPAC, AED
Mentor Contact Email: sabina.zak@nychhc.org
Mentor Contact Phone: 718-616-3447
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist?
The New York City Health and Hospitals Corp. (HHC) - of which Coney Island is part - put a committee together to consider the WHO Checklist and consequently decided to pilot it at six HHC hospitals, including Coney Island. Coney Island already had a surgical checklist that included timeout, so we modified the WHO Checklist to incorporate Joint Commission requirements and standardized the checklist throughout our entire facility for all procedures.
Prior to testing, we provided the available research to make the case for using the checklist. We also did chart reviews to find examples from our own hospital of cases when having the checklist might have prevented a complication, e.g., equipment malfunctions that likely would have been prevented if the equipment check included on the checklist had been done prior to induction.
The checklist was first tested in one OR (1/8 OR) for a period of one month back in July with a dedicated OR staffed team that included a surgeon, anesthesiologist, and nursing. The team underwent training and a demonstration on how to effectively use the checklist. This included outlining the responsibilities of staff members and the importance of verbal communication. As we observed the team, we created a PI checklist that is monitored by nursing staff to include certain indicators such as physician site marking, two patient identifiers used, consent issues, time out performed properly, antibiotic administration within 60 minutes of incision time,etc. Once the issues were identified and the process improved, we had departmental meetings with nursing, surgical attendings, and anesthesia staff to educate our staff about the checklist and its purpose.
In the OR area, we have created a PI project for the checklist to review and monitor compliance. We have printed and laminated the checklist on a large poster and presented the checklist in our national patient safety fair.
What lessons have you learned as you've been testing/implementing the Checklist?
We found that the checklist was being used, but not always verbally. Consequently, we provided additional in-service training regarding the team approach and reinforced the importance of the verbal communication aspect of the process. We also decided to call the checklist the "universal verbal verification checklist" to reinforce the importance of people in the room hearing and verifying every component aloud. We have used video training modules and made presentations to all physicians, nurses and allied health staff to emphasize the tool as a verbal checklist and improve overall communication among staff.
We have always utilized a time out form in our procedure areas, but the newer checklist version has added significant value indicators that are pertinent to successful patient outcomes. It helps the staff ensure that all key components are in place prior to proceeding with scheduled procedures. It has improved staff communication pre- and post-operatively. The importance of the checklist is the verbal communication that is mandated. It's not just a checklist that is checked by one provider, but rather by a team of health care providers dedicated to improving patient care.
How long was your initial test period for the Checklist? 2 months
When did you start broader implementation of the Checklist? September 2008
How many ORs do you have in your organization? 8
How many ORs are currently using the Checklist? 8
What specialties are currently using the Checklist?
All specialties and all OR cases including GI suites, cardiac cath, pulmonary, interventional radiology, inpatient and out-patient areas as well, including dental services.
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist?
All services have been utilizing the checklist in the OR since September 2008
[03/16/09]
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Exempla St. Joseph Hospital - Denver, CO
Availability Status: Available to answer requests
Licensed Beds: 400+
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2009
Mentor Contact Name: Jennifer Misajet
Mentor Contact Email: misajetj@exempla.org
Mentor Contact Phone: 303-837-7668
Additional Information:
Our organization first presented the findings from the WHO team that presented at the IHI Forum in 2008 to the OR Council and requested support for a pilot of the checklist. The OR medical director, senior director surgical/procedural services, and OR manager were the primary proponents of full implementation. Full implementation was supported and approved by the OR Council.
Our organization selected to implement in all ORs simultaneously versus a small test of change. We started the checklist on January 3, 2009 in all operating rooms for all cases. The working group made this decision based on physician recommendation and goal of reducing confusion and variation as staff and anesthesia were assigned in different rooms.
Key changes: Modified the checklist to included required items from the Joint Commission Universal Protocol. This would allow us to use one tool and eliminate the previous “time-out” documentation found on the OR record.
Lessons learned: Even with strong physician support and approval, many surgeons and anesthesiologists needed significant reinforcement to support use of the checklist. Having a physician champion support either formal medical director or key physician leaders facilitates buy-in and acceptance of the change. Staff members continue to need reinforcement not to just “sign- off” all areas; some behavioral coaching has been required for a few individuals. Having the formal paper published in NEJM and OR nursing organizations supporting this initiative has increased staff awareness and understanding of this patient safety initiative. Finally, a conscious decision to keep the checklist a stand-alone, paper document versus incorporating into our pending electronic medical record was selected and agreed upon by leadership, physicians and staff.
It is currently in use in all cases in all operating rooms, all specialties: 24 rooms including IP/OP surgical cases all specialties. We have performed approximately 2500 procedures since instituting the checklist- all procedures (100%) were completed using the Surgical Safety Checklist. We are investigating broader use of the checklist for C-sections, Interventional Radiology and Cardiac Cath Lab procedures.
We are collecting data on “findings” which can be defined as any patient care issues that were identified while using the checklist. We do a random sample of 5 cases from first case starts 5/16-18 scheduled per day M-F. This gives us a representative sample of approximately 10% of our total cases. Data collection from January and February indicate findings in approximately 16% of the cases reviewed. We believe this number to be lower than actual findings and are working with staff to identify any issue discovered on any of the checklist items to be considered a finding.
[04/13/09]
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Lincoln Medical and Mental Health Center - Bronx, NY
Availability Status: Available to answer requests
Licensed Beds: 347
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: July 2008
Mentor Contact Name: Abdul Mondul, MD; Arlinda Racaza, RN; Elaine Stewart Hylton, RN
Mentor Contact Email: Abdul.Mondul@NYCHHC.org
Mentor Contact Phone: 201-491-6314 / 718-579-5280
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist?
- Created a multidisciplinary committee - work group
- Modified the checklist to incorporate WHO, Joint Commission universal protocol and New York State Surgical and Invasive Procedure Protocol elements
- Developed policy and procedures
- Education of nurses in small groups
- Identified and educated surgeon champions
- Initial implementation with general surgery cases
- Expanded use of checklist to all operating rooms/specialties and for out of the OR invasive procedures
- Developed an educational video on the use of the checklist
- Video was mailed by the CEO to all surgeons during Christmas 2008
- Monitoring use of checklist by quality management
- Shared compliance in hospital-wide meetings
- Launched a performance improvement project (PDSA methodology) related to surgical checklist
- Shared accomplishments and process at the Network Patient Safety Committee
- Continuous inservicing
- Media coverage (TV - newspaper - Nursing journal)
What lessons have you learned as you've been testing/implementing the Checklist?
- Initial implementation with a group of champions was an effective way to introduce the concept
- The most important component and outcome was the improvement of communication and teamwork
- Great tool to assure checking of relevant peri-operative processes
- Important to raise awareness and have support at the leadership level
- Continued education and sharing of outcomes through performance improvement project
- Creating a sense of urgency and visibility of the patient safety projects hospital-wide
How long was your initial test period for the Checklist? one month
Has your organization moved to broader implementation? Yes, hospital-wide
If so, when did you start broader implementation of the Checklist? August 2008
How many ORs do you have in your organization?
Eleven(11)
8 Main OR
2 in Labor and Delivery
1 Cystoscopy suite
How many ORs are currently using the Checklist? 11
What specialties are currently using the Checklist?
All specialtites including: General Surgery, Neurosurgery, Vascular Surgery, Orthopedics, Urology, Obstetrics- Gynecology, Plastic Hand surgery, ENT/Ophthalmology, Oral Maxilofacial/Dental, Internal Medicine /subspecialties invasive procedures
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist? 100%
[04/13/09]
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PeaceHealth St. John Medical Center - Longview, WA
Availability Status: Available to answer requests
Licensed Beds: 346
Teaching / Non-Teaching Status: Non-Teaching
Setting: Sub-Urban
Start Date of Intervention Work: January 2009
Mentor Contact Name: Steven Cabrales, MD
Mentor Contact Email: scabrales@peacehealth.org
Mentor Contact Phone: 360-414-7764
Additional Information:
Implementation was facilitated by a well-defined culture of patient safety cultivated over the past few years in our organization. An abbreviated "pilot" of 8 questions printed on two 8" x 11" sheets of paper taped next to a white board and used to augment the "Time-Out" process prepared the OR crews. One month prior to the checklist start date, we met with the departments of surgery, anesthesia, and the OR staff, reviewing the actual checklist, its intended use as a tool to empower every person in the OR to affect patient safety, and the clear responsibility of the operating surgeon as the initiator and driver of the checklist for every procedure.
What key changes did your organization make to incorporate or support use of the Checklist?
Clear responsibility for the checklist was assigned to the surgeon, but authority to "stop the line" for any concerns was given to any and every person in the operating room, and this was supported by the medical staff as well as the administration.
What lessons have you learned as you've been testing/implementing the Checklist?
To prevent procedures from being started without first using the checklist, all scrub techs have been instructed to leave all starting instruments (e.g., scalpel, speculum, scope, etc.) on the back table until the checklist is completed. This prevents the surgeon from just reaching onto the mayo stand to begin the procedure. This was suggested by the scrub techs, and has been implemented in the ORs.
The checklist takes no more than 90 seconds to complete. Those that have resisted using the checklist, stating that it takes too long, have witnessed demonstrations of the checklist in use, or have been offered assistance in their rooms. That offer has yet to be taken, with most surgeons understanding the importance, and efficiency, of the checklist.
How long was your initial test period for the Checklist? ~1 month.
Has your organization moved to broader implementation?
Yes, utilized in every operating room. Not currently utilized in short-stay/procedure areas (e.g., GI, radiology).
When did you start broader implementation of the Checklist?
Official launch day for use in all ORs was 2/3/09.
How many ORs do you have in your organization? 8
How many ORs are currently using the Checklist? 8
What specialties are currently using the Checklist?
General/Thoracic/Vascular, Orthopedics, ENT, GYN, Dental, Podiatry.
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist?
At least 50% since launch day.
[03/16/09]
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Skagit Valley Hospital - Mount Vernon, WA
Availability Status: Available to answer requests
Licensed Beds: 137
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: September 2008
Mentor Contact Name: Joyce Cardinal
Mentor Contact Email: jcardinal@skagitvalleyhospital.org
Mentor Contact Phone: 360-428-8231
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist? What were the changes in existing processes your organization had to make in order for the Checklist to become part of the routine?
One of our surgeons heard about the checklist through SCOAP and became a real champion for using it. He started using it with his own group and then worked one-on-one to introduce it to other surgeons. Our education efforts then spread to the whole department of surgery and then to anesthesia. The spread of the checklist has been a team effort that has included the surgeons, OR nursing staff, anesthesia, and quality.
We made the checklist into a screen saver for our large PACS monitors in every OR so everyone in the room can see the checklist.
How did you roll out the Checklist? Did you test it in one OR, a few, or all to start?
One OR with one surgeon.
What lessons have you learned as you've been testing/implementing the Checklist?
It has been accepted more quickly than we thought it would because of our surgeon champion. Anesthesia has helped it spread.
While some have been skeptical about some parts of the checklist (especially the introduction because we are a relatively small hospital), it's really made a difference in building a sense of everyone being part of a team.
How long was your initial test period for the Checklist?
One room with one surgeon for one month.
When did you start broader implementation of the Checklist?
In November 2008, all of our General Surgeons began using the checklist. On February 1, we sent out letters to all of the surgeons explaining that we will be using the checklist.
How many ORs do you have in your organization?
8 (2 are OB C-section rooms in our Family Birth Center.
How many ORs are currently using the Checklist? 6
What specialties are currently using the Checklist?
General Surgery, Vascular Surgery, Orthopedics, Urology, and most OB-GYN
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist?
Approximately 75%
[03/17/09]
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University of Washington Medical Center - Seattle, WA
Availability Status: Available to answer requests
Licensed Beds: 400+
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: March 2008
Mentor Contact Name: David R. Flum, MD, MPH, Professor, Department of Surgery; E. Patchen Dellinger, MD, Professor and Vice Chairman, Department of Surgery Chief, Division of General Surgery
Mentor Contact Email: daveflum@u.washington.edu; patch@u.washington.edu
Mentor Contact Phone: Flum: (206) 616-5440; Dellinger: (206) 543-3682
Additional Information:
What key changes did your organization make to incorporate or support use of the Checklist?
Gave inservices for every surgical service.
Printed 3' x 5' laminated posters of the checklist and hung them from IV poles for use in every OR. (The ready availability of the checklist in every OR meant that some surgeons started using it even before we were officially fully implementing it.)
General surgeons led by example. We believe that it is important for the attending surgeon to lead the checklist process.
What lessons have you learned as you've been testing/implementing the Checklist?
As a hospital, we were doing the process measures reliably, but using the checklist has provided a mechanism for incorporating briefing and debriefing.
The biggest value of the checklist has been its validation of communication and teamwork.
At first, some surgeons doubt the worth of the checklist, but some skeptics come to rely on it after using it.
How long was your initial test period for the Checklist?
As part of the WHO study, we used it with 500 patients for about a month before and 500 patients after the study period in a month.
When did you start broader implementation of the Checklist?
After providing inservices for every surgical service, we went to full implementation in November 2008.
How many ORs do you have in your organization? 24
How many ORs are currently using the Checklist? 24
What specialties are currently using the Checklist?
All specialties, including orthopaedic, neurosurgery, plastic and reconstructive surgery, otolaryngology and head and neck surgery, urology, oral and maxilofacial surgery, vascular, transplant, cardiac, and OB/GYN.
Approximately what percent of your organization's surgical procedures have been performed while using the Checklist?
General surgery is responsible for approximately 20% of all surgeries and has been using the checklist reliably since March 2008. Between 50-100% of all other services have been using the checklist since November 2008.
[03/16/09]
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