dc.contributor.author | Haugen, Arvid Steinar | |
dc.contributor.author | Wæhle, Hilde Valen | |
dc.contributor.author | Almeland, Stian Kreken | |
dc.contributor.author | Harthug, Stig | |
dc.contributor.author | Sevdalis, Nick | |
dc.contributor.author | Eide, Geir Egil | |
dc.contributor.author | Nortvedt, Monica Wammen | |
dc.contributor.author | Smith, Ingrid | |
dc.contributor.author | Softeland, Eirik | |
dc.date.accessioned | 2019-10-09T08:04:18Z | |
dc.date.available | 2019-10-09T08:04:18Z | |
dc.date.created | 2018-01-24T10:24:58Z | |
dc.date.issued | 2017 | |
dc.identifier.citation | Haugen, A. S., Wæhle, H. V., Almeland, S. K., Harthug, S., Sevdalis, N., Eide, G. E., . . . Søfteland, E. (2019). Causal analysis of World Health Organizationʼs surgical safety checklist implementation quality and impact on care processes and patient outcomes. Annals of Surgery, 269(2), 283-290. | nb_NO |
dc.identifier.issn | 0003-4932 | |
dc.identifier.uri | http://hdl.handle.net/11250/2621071 | |
dc.description.abstract | Objective: We hypothesize that high-quality implementation of the World Health Organization's Surgical Safety Checklist (SSC) will lead to improved care processes and subsequently reduction of peri- and postoperative complications.
Background: Implementation of the SSC was associated with robust reduction in morbidity and length of in-hospital stay in a stepped wedge cluster randomized controlled trial conducted in 2 Norwegian hospitals. Further investigation of precisely how the SSC improves care processes and subsequently patient outcomes is needed to understand the causal mechanisms of improvement.
Methods: Care process metrics are reported from one of our earlier trial hospitals. Primary outcomes were in-hospital complications and care process metrics, e.g., patient warming and antibiotics. Secondary outcome was quality of SSC implementation. Analyses include Pearson's exact [chi]2 test and binary logistic regression.
Results: A total of 3702 procedures (1398 control vs. 2304 intervention procedures) were analyzed. High-quality SSC implementation (all 3 checklist parts) improved processes and outcomes of care. Use of forced air warming blankets increased from 35.3% to 42.4% (P < 0.001). Antibiotic administration postincision decreased from 12.5% to 9.8%, antibiotic administration preincision increased from 54.5% to 63.1%, and nonadministration of antibiotics decreased from 33.0% to 27.1%. Surgical infections decreased from 7.4% (104/1398) to 3.6% (P < 0.001). Adjusted SSC effect on surgical infections resulted in an odds ratio (OR) of 0.52 (95% confidence interval (CI): 0.38-0.72) for intervention procedures, 0.54 (95% CI: 0.37-0.79) for antibiotics provided before incision, and 0.24 (95% CI: 0.11-0.52) when using forced air warming blankets. Blood transfusion costs were reduced by 40% with the use of the SSC.
Conclusions: When implemented well, the SSC improved operating room care processes; subsequently, high-quality SSC implementation and improved care processes led to better patient outcomes. | nb_NO |
dc.language.iso | eng | nb_NO |
dc.publisher | Lippincott Williams & Wilkins | nb_NO |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/deed.no | * |
dc.subject | care process | nb_NO |
dc.subject | checklist | nb_NO |
dc.subject | complications | nb_NO |
dc.subject | implementation fidelity | nb_NO |
dc.subject | operating room | nb_NO |
dc.subject | randomized controlled trial | nb_NO |
dc.subject | surgery | nb_NO |
dc.title | Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway | nb_NO |
dc.type | Journal article | nb_NO |
dc.type | Peer reviewed | nb_NO |
dc.description.version | publishedVersion | nb_NO |
dc.rights.holder | Copyright © 2017 The Author(s). | nb_NO |
dc.subject.nsi | VDP::Medisinske Fag: 700::Helsefag: 800 | nb_NO |
dc.source.pagenumber | 283-290 | nb_NO |
dc.source.volume | 269 | nb_NO |
dc.source.journal | Annals of Surgery | nb_NO |
dc.source.issue | 2 | nb_NO |
dc.identifier.doi | 10.1097/SLA.0000000000002584 | |
dc.identifier.cristin | 1550597 | |
cristin.unitcode | 203,3,0,0 | |
cristin.unitname | Avdeling for helse- og sosialfag - Bergen | |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 2 | |