[Assessment of the check-list in the operating room: perceptions of caregivers and physicians (level II assessment)]. / Évaluation de la check-list au bloc opératoire : la perception des soignants et des médecins (évaluation du niveau II).

OBJECTIVE: To assess, a year after the deployment of the check-list in the centre hospitalier Lyon Sud (CHLS - HCL), the perception of medical and nursing staff regarding the advantages of the check-list and its level of integration within the overall organization of the operating room. TYPE OF STUDY: Descriptive study, questionnaires and audits. MATERIALS AND METHODS: Distribution of individual questionnaires to the entire operating room staff, and observational audits in the operating room, to objectively assess the quality of implementation of the check-list (level II of the HAS - French National Autority of Health). RESULTS: The medical and nursing staff participated equally in using the check-list. This was derived from the individual questionnaires and reinforced by the observational audit; they also revealed an uneven implementation of the three phases, with phase 3 almost never performed. In two-third of the cases, the time-out requirements did not comply with HAS instructions. Nurses and physicians perceived the check-list differently. Even though they agreed that the check-list should be a team effort and is useful, nurses noted a lack of investment and leadership from doctors, in addition to communication problems, which led to a feeling of disrespect towards them when they play the role of the check-list coordinator. CONCLUSION: The questionnaire and the audit of practice showed strong adherence to the concept in that the surgical check-list was considered useful by all staff. However, it was also considered to be an added formality and its full implementation was rare in practice. There was a problem of distribution and acceptance of roles with nurses often observing that they were the only ones strictly following the check-list due to a lack of medical investment.

[Implementation strategy of the HAS French surgical check-list in a university hospital]. / Stratégie de déploiement de la check-list dans un CHU.

The check-list (CL) "Safety in Operating Room" has been introduced in our teaching hospital since 2009, associated to a "Quality and Prevention of Risks" program. This introduction was carried out over two distinct phases. The first one was a pilot start including five OR, allowing us to draw firm recommendations on the best way to perform the introduction, followed by a generalization to the other operating room (OR). The recommendations were the followings: a pilot committee including all the professionals should be constituted before the onset of introduction, a dedicated communication should focus on the actual concerns and benefits, and finally, the person questioning other care givers and filling the form should be clearly identified and supported in the OR. Meanwhile a guide on the utilization of the CL in each surgical speciality was written, and a dedicated manager was in charge of the whole procedure. This experience raised several remarks. This implementation of the CL proved to be a cause of self-interrogation on our medical practices, and the opportunity to improve communication among the professionals of the OR. Indeed, the 10 items of the OR should be thought as the last check before the no-return point, which should be shared by anyone in the OR. If these conditions were fulfilled, the CL could be viewed as an actual improvement of safety in the OR. Otherwise, CL is just a supplementary form.