Jan 7, 2010

Implementing the Safe Surgery Checklist in New Delhi, India

This year we started a Global Health Initiative within the Harvard IHI Open School Chapter. We aim to make quality improvement and patient safety truly global. Last year one of the members of the Harvard Open School Chapter, Shabnam Hafiz, introduced the Safe Surgery Checklist at three hospitals in Pakistan. Building upon this momentum and furthering the cause of global patient safety I decided to implement the checklist at hospitals in New Delhi, India during the winter break. As I work on spreading the checklist, I will be sharing my experiences with the readers of this blog. I hope you will find the posts interesting and insightful.

In implementing the checklist, I wanted to do it in a manner that could be replicated by other people wishing to create change, sometimes without significant access to the top leadership at a hospital. I wanted to conduct an experiment in bottom-up change.

One of my physician friends was working as a Resident at a government hospital in Delhi. I got in touch with him when I reached Delhi, and over a cup of coffee I explained the surgical safety checklist to him. He offered to set up an appointment for me to meet with the head of surgery at his hospital to discuss the checklist. Two days after that, I went to the hospital and in a five minute meeting explained the checklist to the Chief of Surgery. She was ready to implement it and remembered having read the journal article. I then met with other surgeons at the hospital, and also the Chief of Anesthesiology. Everyone was ok with the idea and it was decided that I would hold a trial run of the checklist in the OT the next day.

The next day I reached the OR early and explained the checklist to the OR nurses and clarified their doubts. Then I ran the checklist in two OR’s. As this was the first time even for me, I felt a little rushed in the first case and did not feel that the process was as effective as it should have been. In the second case I tried to get some nurses to take over from me, but they were a bit hesitant. In the third case another nurse did volunteer to run the checklist.

What was amazing was that on the very first day we managed to identify gaps in care. One of the questions on the checklist asks ‘Has the site been marked’, it turned out that it was not a routine procedure to mark the incision site preoperatively at this facility; the senior surgeon noted this deficiency and told the surgeons to carry it out for future surgeries. A discussion with the anaesthsiologist revealed that mostly preoperative antibiotics were given in the ward, and the gap between the administration of the antibiotic and the skin incision possibly exceeded 60 minutes in most cases.

After the OR trail run I approached the Administrative Head for his permission to hold a formal presentation to explain the significance of the checklist and to show the videos. He was very supportive and the presentation will be held next week during which I hope to train other people in implementing the checklist.

Suggestions, comments and feedback welcome. Watch this space for updates.