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dc.contributor.authorHaugen, Arvid Steinar
dc.contributor.authorWæhle, Hilde Valen
dc.contributor.authorAlmeland, Stian Kreken
dc.contributor.authorHarthug, Stig
dc.contributor.authorSevdalis, Nick
dc.contributor.authorEide, Geir Egil
dc.contributor.authorNortvedt, Monica Wammen
dc.contributor.authorSmith, Ingrid
dc.contributor.authorSofteland, Eirik
dc.identifier.citationHaugen, 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.description.abstractObjective: 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.publisherLippincott Williams & Wilkinsnb_NO
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internasjonal*
dc.subjectcare processnb_NO
dc.subjectimplementation fidelitynb_NO
dc.subjectoperating roomnb_NO
dc.subjectrandomized controlled trialnb_NO
dc.titleCausal 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 Norwaynb_NO
dc.typeJournal articlenb_NO
dc.typePeer reviewednb_NO
dc.rights.holderCopyright © 2017 The Author(s).nb_NO
dc.subject.nsiVDP::Medisinske Fag: 700::Helsefag: 800nb_NO
dc.source.journalAnnals of Surgerynb_NO
cristin.unitnameAvdeling for helse- og sosialfag - Bergen

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Attribution-NonCommercial-NoDerivatives 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 Internasjonal