Defining, Tracking, and Delivering Excellence in Surgical Care

Surgical Checklist Initiative

♦ Patients » What YOU can do to make your surgery safer

“A System for Safer Surgery”

The SCOAP surgical safety checklist is an example of how SCOAP engages healthcare professionals in active change to improve the way healthcare is delivered. Generous support from the Life Sciences Discovery Fund and Aetna helped finance this initiative.

The Surgical Care and Outcomes Assessment Program (SCOAP) is a unique, clinician-led, voluntary collaborative that links hospitals and surgeons with clinicians from across the state to increase the use of best practices in surgical care. SCOAP’s goal is to provide the kind of surveillance of procedures and response to negative outcomes that exists in the world of aviation.

SCOAP has produced a safety and quality checklist for the OR which is rolling out in all hospitals in Washington State. The checklist is used at the start of surgery as part of an extended "time out" and after surgery as part of a debriefing. The SCOAP OR Surgical Checklist, which goes beyond the JCAHO "time out" concept, guarantees that vital steps to a successful procedure are carried out and reinforces a culture of patient safety.

In January 2009, a coalition of healthcare stakeholders supported the initiative’s goal of having a SCOAP checklist in every OR at every hospital in Washington State by the end of the year. By March 2010, ALL Washington state hospitals (plus some of the free-standing surgery centers) were in the process of implementing the use of the checklist.

The SCOAP checklist is an active way of controlling the variability that exists in surgical care thus creating a system that delivers safer surgery.

How to Implement the SCOAP Surgical Checklist

1. Order SCOAP Surgical Checklist Posters or Download an 8.5” x 11” Paper Version
You can order a 2' x 3' laminated version of the SCOAP Surgical Checklist for your OR by emailing Rosa Johnson at rjohnson@qualityhealth.org or download the .pdf and print your own copy from this website: www.surgicalchecklist.org. Many sites hang a large laminated poster from an IV pole in the OR and check off the steps as they are executed directly on this poster. Alternatively, use the 8.5 x 11 paper version and include the checklist in each basic sterile pack in the OR. We suggest that the large poster be displayed even if your hospital uses a different method of implementing the checklist as it acts as a useful visual aid and helps to reinforce the culture of using the SCOAP Surgical Checklist.

2. Develop a team
The SCOAP Surgical Checklist promotes teamwork and communication in the OR. It is vital that all members of the surgical team (surgery, anesthesia, nursing) are involved and committed to the use of the checklist. It is helpful to identify at least one person from each of these clinical disciplines that will act as a leader in implementing the checklist and bringing other team members on board.

3. Meet with your organization’s leaders
Present the SCOAP Surgical Checklist Initiative to your organization’s leadership. Use the Webex explaining the evolution of the SCOAP Surgical Checklist and the "How To" video demonstrating the use of the SCOAP Surgical Checklist to help with this presentation. You can find both of these here on this website.

4. Bring in Guest Speakers
We can provide clinician/experts to come to your organization to talk about the importance of checklists and the experience of colleagues from across the state with the SCOAP Surgical Checklist. Grand rounds or medical staff meetings may be effective settings to initiate conversations about the checklist.

5. Start focused; then expand/customize
Using your SCOAP Surgical Checklist team, begin to use the checklist within the operating rooms with one group of surgeons, section or specialty. By starting in a more contained manner, challenges can be overcome and refinements made before moving forward to all OR’s and all surgical specialties. It will be easier to gain support for this initiative if the transition is as smooth as possible. Customize the checklist with the input of your team members but don’t remove any of the safety steps already listed on the Checklist.

6. Track changes
Develop methods to track how you are doing in both the use of the Checklist and compliance to the safety steps. A pre- and post-implementation survey is available to assist you in determining staff and physicians' perceptions of surgical safety before and after implementation of the Checklist.

If you are a SCOAP hospital, use your SCOAP data to track how the SCOAP Surgical Checklist is working to ensure that safety standards are being followed. Include your SCOAP data in the spaces provided on the checklist - this will highlight areas that you are focusing on and will help clarify why the use of the SCOAP Surgical Checklist is critical to improving patient safety.

7. Share Success!
Communicate the progress that is being made in the OR so that staff and physicians can be part of this process. This will also encourage support, implementation and continued use of the SCOAP Surgical Checklist. It is also a great way to focus on areas that are not going as well. SCOAP will help spread the message about your participation by conducting a year-long PR campaign -- "The SCOAP checklist as best practice." We encourage you to send your stories to us and we will disseminate them to the public. You can send these to Justine Norwitz, SCOAP Strategic Development Director, jnorwitz@qualityhealth.org.

8. Use SCOAP as a resource
The staff at SCOAP and the Foundation for Health Care Quality are resources if you have questions or need additional information about implementing the SCOAP Surgical Checklist. Contact us any time!

How You Can Help

SCOAP is a grassroots initiative and we rely on the support of stakeholders who are interested in improving the health of Washington State to make this initiative happen. We rely on interested consumer volunteers to inquire about how their local hospitals participate in the checklist initiative. Ask what the results have been. Are there any surgeons who are reluctant to use a checklist? Thank your hospital staff for using a checklist!

The SCOAP checklist initiative also benefits from partners and advocacy groups that seek to advance the vision for safer and higher quality surgical care. We accept donations through the Foundation for Healthcare Quality (a 501(c)3 designated non-profit) as well as donations of in-kind materials and support. The SCOAP checklist initiative is currently seeking sponsors to defray costs or offer services for:

checklist production/reproduction
hanging materials for the checklist across hospitals
media events related to promotion of the checklist initiative
organizational support for local checklist initiative events across the state and in your communities

Surgical Checklist Initiative Update

Congratulations to Washington Hospitals

In January 2009, a coalition of major healthcare stakeholders in Washington came together (see logos at the bottom of page) to create the SCOAP Surgical Checklist Initiative:

SCOAP Surgical Checklist (PDF)

SCOAP Ambulatory Checklist (PDF)

The coalition members set the goal of getting a Surgical Checklist into every OR in Washington State by January 2010, leading to media attention across the state along with a proclamation from the Governor.

According to the Washington State Hospital Association, 100% of Washington State hospitals have either implemented a standardized surgical checklist or are in the process of doing so.

Landmark New England Journal of Medicine study shows how surgical checklists save lives

The SCOAP Surgical Checklist was adapted for use in the United States by SCOAP and surgeons at the University of Washington who pilot tested the WHO checklist currently featured in The New England Journal of Medicine.

"I am a huge fan of SCOAP." -- Atul Gawande, best-selling author and surgeon

"We in surgery have been slow to take collective responsibility for insuring basic standards of good care are followed everywhere surgery is done. Our WHO safe surgery checklist has been proved to reduce deaths and complications by more than a third. But it makes no difference if there is no community participation to use it and measure the results. SCOAP is doing this work. I wholeheartedly endorse its adaptation of the checklist and view the SCOAP initiative to take it statewide as an example for our whole nation."

In this New Yorker article, Gawande illustrates the complexity of intensive care and profiles Peter Pronovost, the Johns Hopkins intensivist and safety leader whose efforts to standardize safety practices led to remarkable reductions in ICU harm in Michigan hospitals.

The article goes on to a broader discussion of how checklists and decision support have reduced errors and transformed safety in critical care. Gawande also reflects on how implementation of standardized approaches often conflicts with the traditional physician culture, which prizes individual expertise over all else.

Related NPR Interview

How a simple checklist can dramatically reduce medical errors.
Pronovost PJ. On Call. IHI Open School for Health Professionals. November 3, 2008.

This new audio program features Peter Pronovost discussing his experience with checklist development and how it might be applied to support other quality improvement targets.