Clinical audit of pre-procedural checklists in an equine referral hospital.

Abstract

Background: Surgical safety checklists have demonstrated a positive impact on post-surgical morbidity/mortality in human medicine, and likely have an equal benefit in veterinary medicine. To realise their advantages, they must be correctly and regularly used. A clinical audit was planned to assess this.

Objectives: To determine the compliance with the pre-procedural request form/surgical safety checklist in a large multi-disciplinary equine referral hospital.

Study design: Retrospective full-cycle clinical audit.

Methods: One hundred and forty-eight checklists (consisting of 23 sub-sections) were examined for completeness. Descriptive statistics were calculated, and section completion rates were compared against national standards. Interventions to improve checklist use were made: a checklist redesign after consultation with end-users, a hospital education scheme to improve staff understanding, regular e-mail reminders, and recruitment of key senior staff as champions. Lastly, it was made policy for checklists to be uploaded to the horse's medical record. Following this, 30 new checklists were re-audited in the same manner. Results obtained were compared against the first audit and national standards.

Results: Checklists were rarely fully complete. In the first audit, completion rates for various subsections ranged from 9% to 89%, with a median value of 64%. In the re-audit, the completion rates ranged from 80% to 100%, with a median value of 93%. The sign-out section was most likely to be incomplete.

Main limitations: Data were not collected in real-time, and it is difficult to determine the significance of missing data. Staff were aware of the re-audit; it is possible that checklist compliance was temporarily increased. Fewer checklists were examined in the second audit.

Conclusions: The interventions have a positive benefit on checklist completion. A clinical audit of checklists is a useful tool that can easily be conducted in practice and may help promote a safety culture within hospitals.