The following questions and answers were developed by the Ontario Hospital Association and the Ontario Ministry of Health and Long-Term Care.
1. What is the Surgical Safety Checklist (SSC)?
The SSC 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 a surgical case 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).
The SSC is used to facilitate operating room team discussion so that everyone is familiar about the case, and reduces reliance on memory for certain necessary interventions
In many ways, the surgical checklist is similar to an airline pilot’s checklist used just before take-off. It is a last minute check to make sure everything is in working order, all equipment is available, and everyone is ready to proceed.
2. Why are SSCs important?
Operating room teams have many important steps to follow in order to ensure a safe and effective surgery for every patient, and the SSC is a useful tool that helps facilitate good communication among the health care team.
Essentially, the checklist is about improving overall teamwork – a critical factor in producing positive clinical outcomes. There is a lot of work being done in Ontario right now to improve patient safety, and the surgical safety checklist is one component.
3. Why are hospitals publicly reporting the SSC indicator?
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 SSC compliance percentages. This is a good thing for hospitals. The public reporting of patient safety indicators is about inspiring improved performance, enhancing patient safety, and strengthening the public’s confidence in Ontario’s hospitals.
Ultimately, using SSCs will improve teamwork and communication in the operating room, which can lead to improved patient care and safety, decreased complications and deaths from surgery, and better operating room efficiency.
5. What type of information is included in a SSC?
SSCs are divided into three parts relating to different phases of a surgery, and each section of the checklist has information that is relevant to that phase. For example, in the Briefing or Pre-induction phase (before the patient is put to sleep), there are questions about blood type, or specific equipment needed for the surgery. This helps ensure that the right blood or equipment is available before the surgery begins.
The Time-Out phase (just before the first incision) contains a “double check” of the surgery site to ensure correctness.
The Debriefing phase (during or after surgical closure) contains information that is relevant to the surgery just completed and includes recovery plans for the patient.
Here are other examples of some checklist items in each phase:
The Briefing Phase:
The “Time Out” Phase:
The Debriefing Phase:
Surgeon reviews important items
Anesthesiologist reviews important items
Nurse reviews correct counts
6. Using a SSC seems like an obvious strategy to use during a surgery. What keeps a hospital from having 100% compliance?
Rollout of SSCs in hospitals has been a phased-in approach, which means some departments and some sites are at varying stages of implementation. With this new benchmarking ability in place, continued improvement and full compliance with the SSC is expected in the time ahead.
It is also important to remember that the SSC compliance indicator is a process measure, measuring the degree to which all three phases (i.e., a briefing, a time out, and a debriefing) of the SSC was performed correctly and appropriately for each surgical patient.
With the new three-phase approach to the SSC, many hospitals and surgical teams need to change the way they work to get all three phases completed. This takes time, as workflow varies in different surgical departments, and different settings. In some cases, physicians have had to completely reorganize their day in order to attend all three phases, and this is not always easy due to their multiple competing priorities.
7. As a multi-site hospital, are you reporting the SSC compliance percentage by corporation or by site?
All hospitals are to report the SSC compliance percentage by site.
8. Where can the public access this information?
Each Ontario hospital will have its compliance rates on their website. See North York General Hospital’s compliance rate under Performance.
Learn more about public reporting and patient safety on the Health Quality Ontario website.
9. Can hospitals compare their SSC compliance rates against other organizations?
The public reporting of hospitals’ SSC 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 indicators, it is important to look at SSC compliance percentage in a broader context. The percentages 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.
10. How is the compliance rate calculated?
Here’s how the compliance percentage is calculated:
# of times all three phases of the surgical safety checklist was performed x 100 = % compliance
The surgical safety checklist is considered “performed” when the designated checklist coordinator confirms that surgical team members have implemented and/or addressed all of the necessary tasks and items in each of the three phases: Briefing; Time Out; and Debriefing.
The SSC compliance indicator measures the degree to which all three phases of the SSC was performed correctly and appropriately for each surgical patient.
Twice a year, hospitals will be posting the percentage of Surgical Safety Checklist compliance on their websites.