• Christofer Rydenfält, Gerd Johansson, Per Odenrick, Kristina Åkerman, and Per Anders Larsson.
• Department of Design Sciences, Lund University, SE-221 00 Lund, Sweden. christofer.rydenfalt@design.lth.se
• Int J Qual Health Care. 2013 Apr 1;25(2):182-7.

BackgroundPrevious research suggests that the World Health Organization Surgical Safety Checklist time-out reduces communication failures and medical complications and supports development of better safety attitudes. Previous research also indicates that different values can affect the implementation of interventions.ObjectiveTo investigate the actual usage of the checklist in practice and to catalogue deviations for the purpose of identifying improvements.DesignTwenty-four surgical procedures were video recorded. The time-out was analysed quantitatively assessing compliance with a predefined observational protocol based on the checklist and qualitatively to describe reasons for non-compliance.SettingThe operating unit of a Swedish county hospital.Main Outcome MeasuresCompliance with checklist items and the participation of different personnel groups. Activities were conducted during the time-out.ResultsHighest compliance was associated with patient ID, type of procedure and antibiotics; the worst with site of incision, theatre nurse team reviews and imaging information. Team member introductions occurred in half of the operations. Surgeons and the anaesthesia team dominated the time-out.ConclusionThe checklist is not always applied as intended. The components that facilitate communication are often neglected. The time-out does not appear to be conducted as a team effort. It is plausible that the personnel's conception of risk and the perceived importance of different checklist items are factors that influence checklist usage. To improve compliance and involve the whole team, the concept of risk and the perceived relevance of checklist items for all team members should be addressed.

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