Using a SSCC seems like an obvious strategy to use during a surgery. What keeps a hospital from having 100% compliance?
Rollout of SSCCs in hospitals has been a phased-in approach, which means some departments and some sites are at varying stages of implementation. With this new benchmarking ability in place, we expect to see continued improvement and full compliance with the SSCC in the time ahead.
It is also important to remember that the SSCC compliance indicator is a process measure, measuring the degree to which all three phases (i.e., a briefing, a time out, and a debriefing) of the SSCC was performed correctly and appropriately for each surgical patient. With the new three-phase approach to the SSCC, many hospitals and surgical teams need to change the way they work to get all three phases completed. This takes time, as work flow varies in different surgical departments, and different settings. In some cases, physicians have had to completely reorganize their day in order to attend all three phases, and this is not always easy due to their multiple competing priorities.
While SSCC compliance is just being publicly reported now, how long have SSCCs been in use?
Operating room teams have long been discussing most of the items covered in the SSCC for many years. Many hospitals have had their own versions of checklists, including "Pre-Operative", "Time Out" and "Surgical Count" checklists.
The new three-phase Surgical Safety Checklist is useful because it organizes all the important information contained in previous checklists at the right intervals in time. It is a team communication tool that is used to inform all team members about important details regarding the patient and the surgery. It reduces reliance on memory so that one person is not responsible for remembering every single step needed for a safe surgery.
The new three phased SSCC was trialed last year in a world-wide study, led by the World Health Organization and Dr. Atul Gawande of the Harvard School of Public Health. The investigators found that using a SSCC could lead to reduced surgical complications and mortality, whether carried out in developed or developing nations. The study appeared in the January 29, 2009 print edition of the New England Journal of Medicine, and started a world-wide movement to adopt surgical safety checklists to improve patient safety.
As a multi-site hospital, are you reporting the SSCC compliance percentage by corporation or by site?
All hospitals are to report SSCC percentage compliance by site.
How frequently is SSCC compliance being publicly reported?
Hospitals will be posting the bi-annual percentage compliance on the hospital's website, with the first reporting period will cover the months of April, May and June 2010.
Where can the public access this information?
Each Ontario hospital will have this information available on their website. In addition, the MOHLTC will also report the same information on its websitewww.ontario.ca/patientsafety
How do we know that a hospital is safe?
Patient safety is a number one priority for all Ontario hospitals. The SSCC compliance percentage is just one indicator.
Patients should know that their hospital is safe, and that Ontario hospitals are committed to ensuring patients receive the highest quality of care possible
Are there costs associated with implementing a SSCC into a hospital/operating room setting?
SSCCs are simply communication tools that often lead to savings more than they lead to additional costs. By improving teamwork and communication in the operating room, hospitals can improve patient care and safety, decrease complications and deaths from surgery, and improve operating room efficiency.
How are hospitals ensuring that staff use the SSCC?
Hospitals are working to create a culture of patient safety, and this involves everyone in the organization - health care administration, health care professionals, and, of course, patients and families. If low compliance rates are identified, hospitals have a variety of tools and resources available to them through a Surgical Safety Checklist Implementation Toolkit that was developed by the OHA and the Ministry of Health and Long-Term Care. The toolkit contains evidence-based best practices to help hospitals improve their SSCC compliance.
Does the SSCC reporting capture an individual physician's performance related to checklist compliance?
The public reporting of patient safety indicators - including the SSCC compliance percentage - has been mandated by the government to help hospitals improve performance, not penalize them. What's more is the SSCC is inherently about improving teamwork, not just individual performance.
Overall, if we identify low SSCC compliance percentages, we will need to review our policies and procedures to ensure they better reflect the evidence-based patient safety practices outlined in the SSCCs.