Impact of Standardized Surgical Checklist on Communication and Teamwork Among Interdisciplinary Surgical Team

A surgical timeout or surgical pause (Tang, Ranmuthugala, & Cunningham, 2014) is a hospital policy in the operating rooms (ORs) which is usually performed immediately prior to a surgical incision or entrance into a body orifice. This is a final verbal confirmation of patient’s identification, planned surgery, and other critical elements to safety that involves multi-disciplinary team such as physicians, nurses, anesthesia providers, and technicians. Poor compliance in the effective performance of surgical timeout results in OR time delays, inadequate preparation of needed intraoperative apparatus, improper administration of required antibiotics, late blood product requests, etc. To improve surgical time out compliance at Los Angeles county hospital (LAC), a quality improvement project standardizing the performance of surgical pause by means of a Standardized Surgical Checklist (SSC) was implemented. This clinical concern is important to be addressed because based on current evidence, performing effective surgical time out using SSC can impact patient safety by reducing complication and mortality rates following surgery (Tang et al., 2014), and can promote good communication and teamwork among medical care team (Fudickar, Horle, Wiltfang, & Bein, 2012; Lyons & Popejoy, 2014). The innovation aims to develop, implement and evaluate the impact of SSC on communication and teamwork among interdisciplinary surgical care team at LAC. The design of this quality improvement project was a pre- and post- innovation survey. The participants were the members of the interdisciplinary care team who participated in surgical time outs before surgical incision at LAC. Descriptive statistics of the sampled surgical team members was expressed in proportion (percentage). This determined the share of each group of professionals (surgeons, anesthesia providers, RNs, technicians) who participated in the pre- and post- intervention survey. The difference in 2 means of the pre- and post-groups was obtained via independent t test, p value<0.05 (two tailed) and was used to analyze any significant improvement in communication and team work among interdisciplinary care team. The survey consisted of 105 participants in the pre-innovation phase and 114 participants in the post-innovation phase (N=219). The mean improvement in communication score in the pre-innovation group was 3.57 (SD=1.252) compared 4.15 (SD=0.989) in post-innovation group. In terms of improvement in team work score, the pre-innovation group had a mean score of 3.63 (SD=1.325) as compared to a mean score of 4.12 (SD=0.997) in the post-innovation group. The results from an independent t-test demonstrated that the mean improvement score for both communication (t=-3.704, df =190, p<.001) and team work (t=-3.028, df =184, p=.003) were significantly higher in the post-innovation group than in the pre-innovation group. The results support the current evidence that the SSC, if effectively implemented, can potentially improve communication and teamwork among interdisciplinary care team. Improvement in these two domains is known to positively impact the safety culture inside the OR.