An empirical investigation into checklist use in surgery

Surgical care is increasing on a global scale. Considering the complexities of the operating theatre environment and the increasing demands on team performance, knowledge must be advanced to ensure that safe surgical care is consistently delivered. Surgical safety checklists are used as part of standard practices in operating theatres in England. However, their overall contribution to patient safety is under global scrutiny. Over the last decade, benefits and pitfalls have been raised, which contribute to an expanding list of barriers and facilitators targeted to improve surgical checklist implementation. Issues of compliance and variable team performance have been studied. To date, no conclusive evidence has been provided to support the continued use or abandonment of surgical checklists. This research aimed to investigate how surgical checklists are used in practice. Two empirical studies were conducted in a mixed methods approach: • Empirical Study I applied direct observation to investigate an official checklist in order to establish current practice of checklist use and quality of performance. • Empirical Study II applied an ethnographical approach to investigate an unofficial checklist in order to understand how it is used as an artefact within the joint cognitive system of the operating theatre. The findings of this research suggest that the use of surgical checklists is variable and complex. The identified issues support the need for a shift in investigations to focus on how surgical checklists are used in practice rather than measuring success factors as a result of their use. This research contributes important findings: both in the methodological and analytical approach to investigating checklist use, and to the current understanding of how checklists are used in surgery. Extensive evidence is provided on actual practice with suggested opportunities for redesign to inform current and future surgical checklist use. Evidence-based recommendations are proposed for future work.