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Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year update from Moldova.

Publication ,  Journal Article
Kim, RY; Kwakye, G; Kwok, AC; Baltaga, R; Ciobanu, G; Merry, AF; Funk, LM; Lipsitz, SR; Gawande, AA; Berry, WR; Haynes, AB
Published in: JAMA surgery
May 2015

Little is known about the sustainability and long-term effect of surgical safety checklists when implemented in resource-limited settings. A previous study demonstrated the marked, short-term effect of a structured hospital-wide implementation of a surgical safety checklist in Moldova, a lower-middle-income country, as have studies in other low-resource settings.To assess the long-term reduction in perioperative harm following the introduction of a checklist-based surgical quality improvement program in a resource-limited setting and to understand the long-term effects of such programs.Twenty months after the initial implementation of a surgical safety checklist and the provision of pulse oximetry at a referral hospital in Moldova, a lower-middle-income, resource-limited country in Eastern Europe, we conducted a prospective study of perioperative care and outcomes of 637 consecutive patients undergoing noncardiac surgery (the long-term follow-up group), and we compared the findings with those from 2106 patients who underwent surgery shortly after implementation (the short-term follow-up group). Preintervention data were collected from March to July 2010. Data collection during the short-term follow-up period was performed from October 2010 to January 2011, beginning 1 month after the implementation of the launch period. Data collection during the long-term follow-up period took place from May 25 to July 6, 2012, beginning 20 months after the initial intervention.The primary end points of interest were surgical morbidity (ie, the complication rate), adherence to safety process measures, and frequency of hypoxemia.Between the short- and long-term follow-up groups, the complication rate decreased 30.7% (P = .03). Surgical site infections decreased 40.4% (P = .05). The mean (SD) rate of completion of the checklist items increased from 88% (14%) in the short-term follow-up group to 92% (11%) in the long-term follow-up group (P < .001). The rate of hypoxemic events continued to decrease (from 8.1 events per 100 hours of oximetry for the short-term follow-up group to 6.8 events per 100 hours of oximetry for the long-term follow-up group; P = .10).Sustained use of the checklist was observed with continued improvements in process measures and reductions in 30-day surgical complications almost 2 years after a structured implementation effort that demonstrated marked, short-term reductions in harm. The sustained effect occurred despite the absence of continued oversight by the research team, indicating the important role that local leadership and local champions play in the success of quality improvement initiatives, especially in resource-limited settings.

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Published In

JAMA surgery

DOI

EISSN

2168-6262

ISSN

2168-6254

Publication Date

May 2015

Volume

150

Issue

5

Start / End Page

473 / 479

Related Subject Headings

  • World Health Organization
  • Time Factors
  • Survival Rate
  • Surgical Procedures, Operative
  • Retrospective Studies
  • Postoperative Complications
  • Patient Safety
  • Oximetry
  • Moldova
  • Middle Aged
 

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Kim, R. Y., Kwakye, G., Kwok, A. C., Baltaga, R., Ciobanu, G., Merry, A. F., … Haynes, A. B. (2015). Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year update from Moldova. JAMA Surgery, 150(5), 473–479. https://doi.org/10.1001/jamasurg.2014.3848
Kim, Rebecca Y., Gifty Kwakye, Alvin C. Kwok, Ruslan Baltaga, Gheorghe Ciobanu, Alan F. Merry, Luke M. Funk, et al. “Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year update from Moldova.JAMA Surgery 150, no. 5 (May 2015): 473–79. https://doi.org/10.1001/jamasurg.2014.3848.
Kim, Rebecca Y., et al. “Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year update from Moldova.JAMA Surgery, vol. 150, no. 5, May 2015, pp. 473–79. Epmc, doi:10.1001/jamasurg.2014.3848.
Kim RY, Kwakye G, Kwok AC, Baltaga R, Ciobanu G, Merry AF, Funk LM, Lipsitz SR, Gawande AA, Berry WR, Haynes AB. Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year update from Moldova. JAMA surgery. 2015 May;150(5):473–479.

Published In

JAMA surgery

DOI

EISSN

2168-6262

ISSN

2168-6254

Publication Date

May 2015

Volume

150

Issue

5

Start / End Page

473 / 479

Related Subject Headings

  • World Health Organization
  • Time Factors
  • Survival Rate
  • Surgical Procedures, Operative
  • Retrospective Studies
  • Postoperative Complications
  • Patient Safety
  • Oximetry
  • Moldova
  • Middle Aged