1. Call 1: Program Introduction

3. Safe Surgery 2015: South Carolina Call Series

4. Step by step instruction on checklist implementation every Tuesday from 10:00-11:00. Calls will be recorded. Office hours to work through barriers with individual hospitals starting May 6 th every Friday from 12:00- 1:00. Materials to assist with implementation

5. Topics We Will Cover Measuring the spread and impact of the checklist Modifying the checklist for your hospital Testing the checklist Engaging physicians in this work Strategies for working with physicians and staff Spreading the checklist in your ORs

6. Getting to Know You

7. 1.Is Your Hospital Doing the JC Time Out? 2.Do You Think That Your Hospital Does it Really Well? 3.Did Your Hospital Try The Checklist During the IHI Sprint? 4.Does Your Hospital Do the Full WHO Checklist for Every Surgical Case?

8. Development of the WHO Surgical Safety Checklist

9. The Problem

10. The 3 Central Problems in Surgical Safety Throughout the World Unrecognized as public health issue Lack of data on surgery and outcomes Even though we know what to do, but we don’t do it consistently

11. Global Annual Procedure Rates Source: WHO, 2008

12. Four Categories for Surgical Standards: CONTROL OF INFECTION AND CONTAMINATION ANESTHESIA AND PATIENT MONITORING SURGICAL OPERATOR QUALITY ASSURANCE

13. The Safe Surgery Saves Lives Program

14. Guiding Principles Simple Widely applicable Measurable Address serious and avoidable surgical complications Zero harm from the Checklist

15. Checklist Development Overview Launched and widely disseminated the Checklist Studied the effect that the Checklist had in 8 hospitals worldwide Tested the Checklist on a small scale and modified as needed Small working groups were created to narrow down the list to 19 items Gathered experts from all relevant disciplines Analyzed List Developed a compressive list of every way to improve surgical safety globally Creation of the WHO Safe Surgery Saves Lives Project, 2007

17. Pilot Study

18. London, UK EUROEMRO WPRO I SEARO AFRO PAHO I Amman, Jordan Toronto, Canada New Delhi, India Manila, Philippines Ifakara, Tanzania WPRO II Auckland, NZ PAHO II Seattle, USA International Pilot Study 8 Evaluation Sites - Nearly 8,000 Patients

19. Results – All Sites BaselineChecklistP value Cases 37333955- Death 1.5%0.8%0.003 Any Complication 11.0%7.0%<0.001 SSI 6.2%3.4%<0.001 Unplanned Reoperation 2.4%1.8%0.047

20. Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229) The checklist was easy to use78.6% The checklist improved operating room safety 79.0% The checklist took a long time to complete18.3% Communication was improved through use of the checklist 84.3% The checklist helped prevent errors in the operating room 78.2% If I were having an operation, I would want the checklist to be used 92.6%

21. Site C Baseline (n=524) Checklist (n=598) Abx Given 0-60 Mins Except Dirty Cases 98.1%96.9% Adherence to All Six Safety Indicators 94.1%94.2% SSI 4%2.0%* Death 1.0%0.0%* Any Complication 11.6%7.0%* *p<0.05

22. Teamwork and Communication

23. The Checklist – September 2006 to December 2009 Quite a trip

44. What to Take Home The checklist is a checklist but it is also more than a list of checks. It is a list of things that we should do for every patient every time. It is a powerful tool to help us communicate. It is going to take time for us to do this work the way that it needs to be done.

45. Homework Gather an implementation team.

46. Make an Implementation Team Nursing Administration Anesthesia Surgery Once the work begins the team should work weekly during the project

47. Find Clinical Champions The nurses will know Pick those who are respected and who will be supportive The support of “formal” leadership is absolutely necessary but those leaders are often not the ones who should guide this effort directly

48. Homework Gather an implementation team. Schedule a time and venue for a meeting to take place in 8-10 weeks. Read background materials on the checklist. We will send you links to the documents following this call. Create a list using the excel template provided to you of all of the OR staff, physicians, and techs. Send us a picture of your checklist implementation team

49. ? ? Questions

50. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu