Analysis of three years long experience in the use of surgical safety check list at Bassini Hospital of the Istituti Clinici di Perfezionamento in Milan, Italy

Bassini Hospital is a Joint Commission accredited public hospital of ICP (Istituti Clinici di Perfezionamento) of Region Lombardy, in Italy. Bassini Hospital performs about 8000 surgical procedures/year. A project to improve the safety of surgical care has been developed since 2006. A written synoptic map reporting the assessment criteria and the preoperative procedures advised according to EBM for each surgical procedure have been provided to support the “operating team” constituted by surgeons, anaesthetists, nurses, technicians and other operating room personnel involved in surgery. A specific checklist to trace the sequence of activities during preoperative evaluation, surgical intervention and postoperative care has been implemented in order to ensure consistency and completeness in carrying out complex tasks and in order to support the provision of a standardized care. Forms have been included in the integrated patient health record that has been designed according to Joint Commission Standards. Checklist has been developed by multidisciplinary teamwork, according to principles of simplicity, widely applicability and easy measurability of their impact. Quality Assurance of forms using mechanisms for assessment, monitoring, and feedback of procedure application is regularly performed three times/year. To monitor progress and improvement in safety, an electronic incident reporting system has been implemented in parallel as a measurement system. The consistent use of this checklist has showed to reduce significantly the rates of adverse events associated with surgical care. No sentinel events related to surgery occurred, but 3 near miss sentinel event (two “wrong side” and one “wrong patient”) were captured by checklist and time out procedure. Moreover, analysis of forms revealed cases of incorrect documentation and system errors which could potentially have lead to serious error in management. Assessment of quality compilation of checklist, performed since 2007, shows a significant improvement to optimal score in 99%.