Frequently asked questions about surgical safety checklist (SSCL)

Patient safety is a number one priority for all KGH. There are numerous checks and balances in place to ensure the safety of our hospital but hospital care is complicated and depends on many factors. The public reporting of hospitals’ checklist compliance rates is not intended to serve as a measure for hospitals to compare themselves against other organizations, or for the public to use as a measure of where to seek care. Like other patient safety indicators, it is important to look at checklist compliance rates in a broader context. The rates must be examined in order to get a sense of how hospitals are performing – where they excel and where improvements could be made. It is important to look at all of these indicators in combination.

The public reporting of our surgical checklist percentage compliance allows us to establish a baseline from which we can track over time. We will closely monitor our rates and should they decrease, we will look closely at our operating room processes and target areas for improvement. The checklist percentage compliance measures the degree to which all three phases (i.e., a briefing, a time out, and a debriefing) of the checklist were performed correctly and appropriately for each surgical patient. We are always striving for 100 per cent compliance. 

Hospitals will post their bi-annual percentage compliance at the end of July and January.

KGH implemented the checklist in one surgical specialty in November 2009. The checklist was implemented in all surgeries in April 2010.

As part of the Ministry of Health and Long-Term Care’s public reporting of patient safety indicators initiative, eligible hospitals are legally required to post their checklist compliance percentages. KGH strongly supports the provincial government’s strategy to publicly report patient safety Indicators because we believe it will enhance patient safety and strengthen the public’s confidence in our hospitals.

The Canadian Patient Safety Institute has a checklist template that has mandatory requirements for Ontario hospitals to use. KGH then adds additional items to this template that allows us to customize items to fit the type of surgeries performed here and have been declared to be important to the KGH patient population. 

If you undergo a surgery at Kingston General Hospital, you can expect that the surgical safety checklist will be used as part of the procedure. As a patient, you will be asked questions by a surgical team member so that they can complete a portion of the checklist with you.  It will then be used by your surgical team members before, during and after your surgery to help the surgical team members familiarize themselves with your medical history and any special requirements that may be needed for your individual case. 

Operating room teams have many important steps to follow in order to ensure a safe and effective surgery for every patient. The checklist is a useful tool that helps promote good communication and teamwork among the health care team to help ensure the best outcomes for patients.

The checklist is used at three distinct stages or phases during surgery:

• pre-induction (before the patient is put to sleep)
• time out (just before the first incision)
• and debriefing (during or after surgical closure)

Some examples of items contained in the checklist include:

The briefing phase:

• Verify with patient name and procedure to be done
• Allergy check
• Medications check
• Operation site, side and procedure
• Lab tests, X-rays

The “time out” phase:

• Patient position
• Operation site and side and procedure
• Antibiotics check

The debriefing phase:

• Surgeon reviews important items
• Anesthesiologist reviews important items
• Nurse reviews correct counts 

A surgical safety checklist is a patient safety communication tool that is used by a team of operating room professionals (nurses, surgeons, anesthesiologists, and others) to discuss important details about each surgical case. In many ways, the surgical checklist is similar to an airline pilot’s checklist used just before take-off. It is a final check prior to surgery used to make sure everyone knows the important medical information they need to know about the patient, all equipment is available and in working order, and everyone is ready to proceed.