Surgical Safety Checklist Observation Report
Sample Report
January 1st, 2012 – March 1st 2012
Thank you so much for performing observations in your operating room using the Safe Surgery 2015: South Carolina
observation tools and for sending us your data. In your cases it appears that observers are doing a good job assessing
checklist use and teamwork in the operating room. This report is a summary of how the checklist was used in your
operating rooms for cases observed. This information should be used to further improve checklist implementation and
surgical outcomes.
This report does not contain results from the observations that you performed using the Teamwork Observation Tool. We
are still analyzing the data from the teamwork observation tool and we will follow-up with information about these at a later
date.
This report contains the following elements:

Checklist Performance Feedback (Page 2-3): Provides detailed results on the use of the checklist by surgical
teams in your hospital.

Summary Benchmark (Page 4): Portrays your hospital’s performance in comparison to other South Carolina
hospitals.

Feedback Summary (Page 5): Summarizes the strengths as well as opportunities to improve the performance of
the checklist at your hospital.
If you have any questions or would like to set-up a time to talk to our team about your results or this project in general
please contact Lizzie Edmondson at [email protected] or 617-432-1503.
Many Thanks,
The Safe Surgery 2015: South Carolina Team
Surgical Checklist Performance Feedback
April 13th, 2011 – November 10th, 2011
The following results are characterized as fitting one of three categories:
Areas of strength (95%-100%)
Areas that can be approved upon, but might not be the top priority (50%-94%)
Areas in need of improvement (0%-49%)
Table 1: Overall Checklist Use:
Cases
Observed
Percent of
Cases
All items on the checklist were performed1 - Every Patient, Every Time, Everything
10
7%
All checklist items were read aloud, without reliance on memory (Q11)
10
35%
Table 2: Percentage of cases in which each team member actively participated in the Joint Commission Timeout
(verification of patient identify, procedure, and operative site before skin incision):
Team member (Q4)
Cases
Observed
Percent of
Cases
Anesthesia provider
10
96%
Circulating nurse
10
100%
Surgeon
10
40%
Surgical tech
10
70%
SCIP Items (Q1-3)
Applicable
Cases2
Percent of
Cases
Antibiotic given within 1 hour of incision
10
99%
Compression boots placed (mechanical DVT prophylaxis)
8
92%
Warmer placed (for case >1 hour)
10
94%
Table 3: Percentage of cases in which SCIP items were performed:
1
All items on the checklist were considered performed when all SCIP applicable measures (Q1-Q3) were performed, at
least one individual on the team performed the Joint Commission Timeout (Q4), team members introduced themselves or
the team was previously established (Q5, Q5a), and all briefing (Q6-10) and debriefing items (Q12-14) were completed.
2 Applicable cases are the cases in which the observer reported that the SCIP measure was either performed or should
have been performed.Cases were excluded when the observer responded “N/A”.
Surgical Safety Checklist Observation Report - January 1st, 2012 – March 1st 2012
2
The following results are characterized as fitting one of three categories:
Areas of strength (95%-100%)
Areas that can be approved upon, but might not be the top priority (50%-94%)
Areas in need of improvement (0%-49%)
Table 4: Percentage of cases in which briefing Items were performed:
Briefing Items (Q5-10)
Cases
Observed
Percent of
Cases
Team members introduced themselves by name and role
(e.g., “Lynn, the anesthesiologist.”)
OR
Teams were established (i.e., introductions performed earlier the same day)
10
35%
Surgeon discussed the operative plan
10
50%
Surgeon stated the expected duration of the procedure
10
30%
Surgeon communicated the expected blood loss to the team
10
20%
Nurse discussed sterility, equipment, or any other concerns
10
99%
Anesthesia provider discussed the anesthesia plan (including airway or other concerns)
10
70%
Cases
Observed
Percent of
Cases
10
93%
10
30%
10
40%
Table 5: Percentage of cases in which debriefing items were performed:
Debriefing Items (Q12-14)
Before the patient left the OR, the team discussed specimen labeling (e.g., labels /
patient name read aloud)
Before the patient left the OR the team discussed equipment or other problems
that arose
Before the patient left the OR, the team discussed key concerns for patient recovery
and post-op management
Surgical Safety Checklist Observation Report - January 1st, 2012 – March 1st 2012
3
(%)
Percent (%)
Summary Benchmark:
Your Hospital’s Performance of the Three Sections of the Checklist Compared to Other SC Hospitals 3
3
This benchmark is a weighted average of the three checklist components: SCIP (Questions 1-3), Briefing (Questions 510), and the Debriefing (Questions 12-14), with each of the three components given equal weight.
Surgical Safety Checklist Observation Report - January 1st, 2012 – March 1st 2012
4
Feedback Summary
Visible Checklist Impact:

Using the checklist has prevented four errors or omissions in the 10 cases that were observed.
Strengths:

The SCIP Measures are consistently performed in your operating rooms.

The nursing teams and anesthesiologists are actively engaged in performing the checklist and the Joint Commission Time
Out.

Virtually every surgical team confirms that the specimens are properly labeled at the end of the case.
Areas in Need of Improvement:

The checklist was performed in its entirety (i.e., every one of items on the checklist were completed) in 7% of the observed
cases. This indicates that surgical teams often skip items on the checklist or when they perform checklist items they do not
read them aloud so that the entire surgical team can hear them and participate. At times surgical team members skip
checklist items that they feel are not applicable to the case or that they believe cover information that everybody already
knows. We recommend that instead of skipping over these items entirely that they still be read aloud from the checklist. For
example, in a case where only minimal blood loss is expected, instead of the skipping that item the surgeon should say,
“minimal blood-loss”.

All checklist items were read aloud in only 35% of the observed cases. Reading the checklist aloud from a poster or a
paper copy of the checklist is extremely important. Many clinicians feel that they can memorize the checklist and that
performing the checklist from memory is adequate. Every item on the checklist should be read aloud at a time when the
appropriate people are in the room and participating. When a checklist is not read from a hard copy critical items are often
missed.

Surgeons and the surgical technicians are not as actively engaged in the Joint Commission Timeout as the other team
members. Every member of the surgical team should be actively engaged in the Time Out and during the entire surgical
checklist.

Some of the most common items that are omitted from the checklist in your ORs are those that prompt the surgeon to share
the expected duration of the procedure and the expected blood loss. Every hospital has struggled with these two items
being performed for every patient every time. Surgeons often assume that the entire team already knows this information
and that it is not worthwhile to say. While many of the cases may be considered routine and the blood loss and duration are
not considered an issue, there are those rare instances that sharing this information will significantly impact the patient. We
encourage you to talk to some of the surgeons and ask them why they don’t use these two items on the checklist.
Take Home Messages:

Consider having the people that are observing these cases coach surgical teams on their use of the checklist in the
operating room or following the case. Often times, real-time feedback can help teams use the checklist better.

Ensure that all surgical team members in the operating room can read from a hard copy of the checklist. People often hang
posters, but they might not be large enough for everybody to read. We have learned that the larger the size of the checklist
in the operating room, the greater the importance it signifies.

Consider holding training sessions outside of the operating room on how to use the checklist and on clarifying everybody’s
role in using the checklist.

Work with surgical teams to ensure that every member of the team says something before skin incision. We believe that if
teams are well established it is okay not to introduce themselves by name and role. Instead a best practice is to have every
team member say something before skin incision. To accomplish this, some hospitals start the before skin incision portion
of the checklist with an icebreaker or a statement by every team member immediately before skin incision that they are
ready to proceed.
Surgical Safety Checklist Observation Report - January 1st, 2012 – March 1st 2012
5