Timing In: Evaluating the potential for a patient-centric modification of the WHO Surgical Safety Checklist

The World Health Organization Surgical Safety Checklist (SSC) is a tool to avoid errors and improve communication and teamwork. It can improve outcomes after surgery provided teams engage and that its use aligns to clinical context. However, the SSC does not explicitly involve patient participation, even though patients are often awake during the sign-in phase of cardiac surgery and during many procedures in the catheter laboratory. This is a missed opportunity to check key facts (patients can be an excellent source of key information about themselves), and to personalize each patient in the minds of the surgical or cardiology team. The importance of cultural safety is increasingly recognized and emphasized by both the medical and nursing councils of New Zealand. However, the SSC was developed in a culturally agnostic manner, and with no reference to obligations of the healthcare system in Aotearoa/NZ under Te Tiriti o Waitangi. Many aspects of investigative and interventional cardiology and cardiac surgery are challenging and unique to these specialties. Little work has been done to optimize the use of the SSC in these specialties at Auckland City Hospital. Thus, we plan to evaluate its use in cardiac catheterization laboratories and cardiac surgical operating rooms at Auckland City Hospital, through observation and then interviews of clinicians and patients, seeking opportunities to improve its use and to make it more patient centric and facilitatory of cultural safety (as an important, hitherto overlooked element of safety culture). This work will inform potential further enhancements to safety, to outcomes for patients and to the wellbeing of operating room staff involved in cardiac surgery and cardiac catheterization procedures.