EP633 - One size does not always fit all: Assessment of the surgical safety checklist in colorectal surgery

Purpose/Background: The WHO Surgical Safety Checklist (SSC) is widely used and linked to improved patient safety and outcomes, but its performance is variable. A universal checklist may not meet the needs of specialized services such as colorectal surgery. To address this, the High-Performance Checklist (HPC) Toolkit was developed as a standardized way of addressing performance gaps in the current use of the SSC and identifying potential opportunities to enhance SSC capabilities - ultimately supporting SSC customization and reimplementation. This study presents the first application of the HPC to colorectal surgery. We present a mixed-methods assessment of SSC performance deficits and opportunities identified by the HPC toolkit which will be used to develop a tailored colorectal surgery SSC.

Methods/Interventions: To evaluate current SSC use and perceptions, we conducted standard HPC surveys, semi-structured interviews of surgical attendings and fellows, and intraoperative SSC observations using the Checklist Performance Observation for Improvement (CheckPOINT) tool. Quantitative data from surveys and observations were analyzed using SPSS and Excel. Interview transcripts were thematically analyzed by two reviewers using NVivo.

Results/Outcomes: Six survey responses from colorectal surgeons and fellows revealed gaps in SSC performance and barriers to use, including resistance to change and time pressure (Figure 1). Six CheckPOINT observations showed declining performance across SSC pause points (Figure 2). Adherence was highest at the briefing stage and decreased during the time out and debriefing phase. Additionally, team engagement declined, particularly during debriefing.

Five interviews of colorectal surgeons and fellows highlighted the SSC's value as a communication tool. Barriers included excessive wordiness, limited engagement, and discomfort discussing certain items in front of patients. Suggestions for colorectal-specific improvements included: identifying anemic patients, expanded position discussions, detailed equipment reviews, and a dedicated pause before anastomotic construction. The checklist was thought to be a useful tool for discussion of patient-specific complications and postoperative plans, particularly pain management.

Conclusion/Discussion: Preliminary findings suggest opportunities to improve SSC usability and relevance for colorectal surgery using the HPC. Key areas that could be addressed include streamlining checklist structure and incorporating specialty-specific discussion points. Next steps involve qualitative interviews with anesthesiology and nursing teams, followed by development of a colorectal-specific SSC. By addressing identified needs through the HPC Toolkit's customization process, we aim to enhance checklist engagement and performance in future work.

Figure 1. Survey results of the current use of the Surgical Safety Checklist
Figure 2: Baseline CheckPOINT observation scores
(Scoring is on a 7-point Likert scale where 1 is extremely disengaged and 7 is extremely engaged)