Validation of a Norwegian version of SURgical PAtient Safety System (SURPASS) in combination with the World Health Organizations' Surgical Safety Checklist (WHO SSC)

Abstract

Introduction: Surgical safety checklists may contribute to reduction of complications and mortality. The WHO's Surgical Safety Checklist (WHO SSC) could prevent incidents in operating theatres, but errors also occur before and after surgery. The SURgical PAtient Safety System (SURPASS) is designed to intercept errors with use of checklists throughout the surgical pathway.

Objective: We aimed to validate a Norwegian version of the SURPASS' preoperative and postoperative checklists for use in combination with the already established Sign In, Time Out and Sign Out parts of the WHO SSC.

Methods and materials: The validation of the SURPASS checklists content followed WHOs recommended guidelines. The process consisted of six steps: forward translation; testing the content; focus groups; expert panels; back translation; and approval of the final version. Qualitative content analysis was used to identify codes and categories for adaption of the SURPASS checklist items throughout Norwegian surgical care. Content validity index (CVI) was used by expert panels to score the relevance of each checklist item. The study was carried out in a neurosurgical ward in a large tertiary teaching hospital in Norway.

Results: Testing the preoperative and postoperative SURPASS checklists was performed in 29 neurosurgical procedures. This involved all professional groups in the entire surgical patient care pathway. Eight clinical focus groups revealed two main categories: 'Adapt the wording to fit clinical practice' and 'The checklist items challenge existing workflow'. Interprofessional scoring of the content validity of the checklists reached >80% for all the SURPASS checklists.

Conclusions: The first version of the SURPASS checklists combined with the WHO SSC was validated for use in Norwegian surgical care with face validity confirmed and CVI >0.80%.

Trial registration number: NCT01872195.

Keywords: checklists; patient safety; quality improvement; surgery; transitions in care.

Figure 1

Compliance to the preoperative and postoperative SURPASS checklists according to professional background when testing the content in 29 neurosurgical procedures, June–July 2012, in one Norwegian hospital. PACU, postanaesthesia care unit.

Figure 2

Qualitative content analyses to understand eight focus groups’ perspectives on the tested preoperative and postoperative SURPASS checklist content for neurosurgical procedures in one Norwegian hospital. OT, operating theatre; PACU, postanaesthesia care unit.