Vis enkel innførsel

dc.contributor.authorHaugen, Arvid Steinaren_US
dc.contributor.authorWæhle, Hilde Valenen_US
dc.contributor.authorAlmeland, Stian Krekenen_US
dc.contributor.authorHarthug, Stigen_US
dc.contributor.authorSevdalis, Nicken_US
dc.contributor.authorEide, Geir Egilen_US
dc.contributor.authorNortvedt, Monica Wammenen_US
dc.contributor.authorSmith, Ingriden_US
dc.contributor.authorSofteland, Eiriken_US
dc.date.accessioned2018-08-24T09:14:09Z
dc.date.available2018-08-24T09:14:09Z
dc.date.issued2019
dc.PublishedHaugen AS, Wæhle HV, Almeland Sk, Harthug S, Sevdalis N, Eide GE, Nortvedt MW, Smith I, Softeland E. Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway. Annals of Surgery. 2019;269(2):283-290.eng
dc.identifier.issn0003-4932
dc.identifier.issn1528-1140
dc.identifier.urihttps://hdl.handle.net/1956/18225
dc.description.abstractObjective: We hypothesize that high-quality implementation of the World Health Organization's Surgical Safety Checklist (SSC) will lead to improved care processes and subsequently reduction of peri- and postoperative complications. Background: Implementation of the SSC was associated with robust reduction in morbidity and length of in-hospital stay in a stepped wedge cluster randomized controlled trial conducted in 2 Norwegian hospitals. Further investigation of precisely how the SSC improves care processes and subsequently patient outcomes is needed to understand the causal mechanisms of improvement. Methods: Care process metrics are reported from one of our earlier trial hospitals. Primary outcomes were in-hospital complications and care process metrics, e.g., patient warming and antibiotics. Secondary outcome was quality of SSC implementation. Analyses include Pearson's exact χ 2 test and binary logistic regression. Results: A total of 3702 procedures (1398 control vs. 2304 intervention procedures) were analyzed. High-quality SSC implementation (all 3 checklist parts) improved processes and outcomes of care. Use of forced air warming blankets increased from 35.3% to 42.4% (P < 0.001). Antibiotic administration postincision decreased from 12.5% to 9.8%, antibiotic administration preincision increased from 54.5% to 63.1%, and nonadministration of antibiotics decreased from 33.0% to 27.1%. Surgical infections decreased from 7.4% (104/1398) to 3.6% (P < 0.001). Adjusted SSC effect on surgical infections resulted in an odds ratio (OR) of 0.52 (95% confidence interval (CI): 0.38–0.72) for intervention procedures, 0.54 (95% CI: 0.37–0.79) for antibiotics provided before incision, and 0.24 (95% CI: 0.11–0.52) when using forced air warming blankets. Blood transfusion costs were reduced by 40% with the use of the SSC. Conclusions: When implemented well, the SSC improved operating room care processes; subsequently, high-quality SCC implementation and improved care processes led to better patient outcomes.en_US
dc.language.isoengeng
dc.publisherWolters Kluwereng
dc.rightsAttribution CC BY-NC-NDeng
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/eng
dc.subjectcare processeng
dc.subjectchecklisteng
dc.subjectcomplicationseng
dc.subjectimplementation fidelityeng
dc.subjectoperating roomeng
dc.subjectRandomized controlled trialeng
dc.subjectSurgeryeng
dc.titleCausal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norwayen_US
dc.typePeer reviewed
dc.typeJournal article
dc.date.updated2018-06-25T09:40:15Z
dc.description.versionpublishedVersionen_US
dc.rights.holderCopyright 2017 The Author(s)
dc.identifier.doihttps://doi.org/10.1097/sla.0000000000002584
dc.identifier.cristin1550597
dc.source.journalAnnals of Surgery


Tilhørende fil(er)

Thumbnail

Denne innførselen finnes i følgende samling(er)

Vis enkel innførsel

Attribution CC BY-NC-ND
Med mindre annet er angitt, så er denne innførselen lisensiert som Attribution CC BY-NC-ND