Dossier n. 242/2014 [Abstract] The SOS.net project. A regional network for the implementation of the Surgical Safety Checklist

In 2008, WHO diffused the “Guidelines for Safe Surgery” and subsequently the Italian Ministry of Health published their Recommendations on the same matter. In 2010, following these publications, the Regional Agency for Health and Social Care in Emilia-Romagna, supported by the Modena University-Hospital and by a Regional coordination group, launched the SOS.net Project, aimed to implement the surgical safety checklist in order to improve safety in the operating room and to prevent potentially avoidable adverse events. The regional checklist, slightly modified compared to the original version of the Surgical Safety Checklist, is composed of two forms, including a set of controls to be carried out along the surgical procedures and supporting the detection of several possible deviations from the standard.

The authors reviewed (not systematically) the international literature: the second Chapter summarizes the introduction of the checklist across different countries, in local contexts and various clinical specialties; it describes the scientific evidence supporting the effectiveness of the checklist both on clinical outcomes and improvement of teamwork and communication. Some studies also report some critical aspects concerning the implementation of the tool in the daily practice.

Chapter 3 offers a short overview of some national and regional experiences in the field of surgical safety.

The fourth Chapter describes the experience of the Emilia-Romagna region, particularly focusing on different steps of the SOS.net Project: the development of a network of health care organisations and local teams as well as the adaptation of the checklist to the regional context, building a specific database and fostering a cascade education process.

Chapter 5 reports the results achieved in 2011-2012, with a further focus on the year 2013: in 2012, 73% of the hospitals with surgical care were formally recruited, whereas 68% were able to document the use of the checklist through the dedicated regional database. Overall, the use of the checklist was registered in over 96,000 surgical procedures (31% of the total number of surgeries delivered at regional level) and 3,450 deviations from the standard were reported. Finally, the Chapter summarizes the main findings of a survey targeting healthcare professionals with a half structured questionnaire and investigating the local development of the Project, problems encountered in routine implementation, compliance of the team and the introduction of ameliorating actions.

The discussion (Chapter 6) focuses on two important issues: firstly, the systematic use of the pre-operative checklists and anaesthesia checklists to prevent operative and post-operative events is one of the 10 Patient Safety Strategies strongly encouraged at international level (Shekelle, 2013); secondly, the compliance to the tool is related to the combination of values, motivations, human relations, accountability and well-established ways people interact (Greenhalgh, 2012). Finally, the document discusses the possible future developments of the Project and highlights the relevance of including the use of the checklist in a more general commitment to safety in surgery.