The impact of improved surgical safety checklist participation on OR efficiencies: A pretest-post test analysis

Objective: To describe changes in day of surgery (DOS) cancellations and procedural delays following introduction of a practice improvement intervention to improve team members’ participation in the surgical safety checklist (SSC). Methods: Pretest—posttest electronic audit of secondary data collected 12 months before and 12 months after implementation. A consecutive sample of patients who underwent elective surgeries were included. Elective surgeries over two periods (November 2014 to September 2015, and November 2015 to October 2016) were included in the audit and data was collected retrospectively. The practice improvement intervention coined ‘pass the baton’ was implemented over four weeks in October 2015. Results: Across audit periods 33 017 surgical procedures (16 262 pretest and 16 755 posttest) were performed. DOS cancellations between phases totalled 826 with an increase of 112 in the posttest phase with the largest posttest increase being in suite cancellation (increase of 97). Across phases, there were 1508 procedural delays (pretest n=737, posttest n =771), with the most frequent delay being due to staff availability (p=0.577). Pretest procedural delays averaged 38.7 minutes (SD 52.4) and posttest averaged 36.8 minutes (SD 43.2) (p=0.428). Conclusions: These results suggest no change in clinical efficiencies when the SSC is fully utilised. That is, increased participation in the checklist does not increase delays in surgery. When considering ways to improve clinical efficiency, hospital administrators need to consider skill mix, physical layout of the OR and additional staffing, factors not captured in routine clinical audit data collected.