TOWARDS BETTER PATIENT SAFETY: The WHO Surgical Checklist in Otorhinolaryngology
Paivi Helmio
https://urn.fi/URN:NBN:fi-fe2021042824386
Tiivistelmä
Paivi Helmio
TOWARDS BETTER PATIENT SAFETY: The WHO Surgical Checklist in
Otorhinolaryngology
From the Department of Otorhinolaryngology, Faculty of Medicine, University of Helsinki, Finland.
Helsinki 2015.
More than one-half of adverse events in health care are related to surgery. Surgical patient injuries account
for about 80% of patient injuries in otorhinolaryngology (ORL). The World Health Organisation
(WHO) has developed a Surgical Safety Checklist to prevent errors in the operating theatre. Its use has
been shown to reduce complications and mortality. The aims of the present study were to identify errors
that may underlie those patient injuries that occur in operative ORL, to assess the effects of the WHO
checklist on working processes in the operating theatre, including compliance, and to evaluate how it
would fit into the specialty.
Data of the patient injuries that were sustained during treatment by the ORL specialty between the
years 2001 and 2011 were obtained from a search of the Finnish Patient Insurance Centre registry. The
causes of the injuries were analysed, and whether the WHO checklist could have prevented the error
was evaluated. The checklist was implemented in four Finnish hospitals as a pilot in 2009. A prospective
before-versus-after-intervention study was conducted with a questionnaire for OT personnel in these
four hospitals to evaluate the checklist. The checklist was subsequently implemented for regular use in
the operative unit of the Department of Otorhinolaryngology of Helsinki University Central Hospital.
After one-year of use, compliance and user attitudes were analysed by using data obtained from the
operations database and a survey of operative ORL personnel.
In the 10-year study period, 188 patient injuries were associated with operative ORL. A total of 142
(75.5%) of these injuries occurred due to errors that were made in the operating theatre, and in 125
cases (66.5%) a manual error in performing the surgery was the primary cause of the injury. Six injuries
(3.2%) were caused by wrong site surgery. An error had some degree correspondence with a WHO
checklist item for 18 injuries (9.6%) and it was determined that 9 of these injuries (4.8%) could have
been prevented had the checklist been correctly used. The implementation of the checklist enhanced
the communication between the surgical team members, improved verification of the patient’s identity
and of the correct operation site. Checklist compliance was 62.3% during first year of use. It was considered
easy to use and the Safety Attitude Scores of the personnel were found to be on a high level.
All check items on the list were considered important for ORL. However, a more compact checklist for
outpatient surgery was requested.
Patient injuries in ORL were strongly related to surgery. The WHO Surgical Safety Checklist seems
to be a beneficial tool for preventing errors ORL and is highly relevant for the specialty.
Keywords: operative otorhinolaryngology, patient safety, adverse event, patient injury, wrong site surgery,
surgical safety checklist
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