Optimize patient safety: understand and apply criterion 2.3-09

Patient safety is at the heart of healthcare facilities' concerns, and the implementation of a checklist has been mandatory since 2010 as part of the healthcare facility certification procedure. This requirement reflects the crucial importance of verification tools in complex environments, similar to aviation, where the checklist appeared following the Boeing 299 accident in 1935, highlighting the complexity of the aircraft and the lack of pre-flight checks. In medicine, pioneers such as Peter Pronovost and Atul Gawande have demonstrated the transformative power of these lists, particularly in reducing infections associated with central catheters or in surgery.

Criterion 2.3-09: a pillar for improving practices

Criterion 2.3-09 for healthcare facilities is an imperative element that stipulates that "Teams in interventional sectors improve their practices by analyzing how the 'Patient Safety' checklist is carried out." This criterion, designed to enhance the safety of surgical interventions, aims for a systematic verification of critical elements at each stage of patient care.

The "Patient Safety" checklist allows for the control of several essential points:

• Patient identification.
• Verification of the operative site.
• Control of devices and equipment.
• Procedure validation.

The Haute Autorité de Santé (HAS) encourages professionals to adapt this checklist to facilitate its appropriation and adoption, recognizing that professionals are the best guarantors of improving patient safety.

By regularly analyzing how the checklist is carried out, teams can:

• Identify deviations or points of vigilance.
• Adjust their practices.
• Improve communication between the different professionals.

This evaluation and adjustment process is fundamental because it directly contributes to preventing errors, optimizing coordination, and ensuring patient safety throughout their interventional journey.

The assessment elements for professionals, according to Criterion 2.3-09, are clear:

• The checklist, possibly adapted according to HAS recommendations, must be systematically and exhaustively completed by the teams in operating rooms and interventional sectors at each stage.
• It must be carried out in the presence of the professionals concerned.
• Assessments of its implementation are monitored by the teams, including the monitoring of Go/No Go decisions.
• Teams must implement improvement actions based on the analysis of the results of the monitoring indicators of the check-list implementation methods.

Safeteam training: mastering the checklist and strengthening teamwork

To support healthcare professionals in mastering these requirements, specialized training courses are offered. The "Checklist and teamwork in the operating room (P01)" program from Safeteam Academy is specifically designed to meet this need. This 2-hour training course (1 hour of self-study and 1 hour of group videoconference) is intended for anyone working in the operating room and concerned by the use of the checklist, without any prerequisites.

The pedagogical objectives of this training are multiple:

• Master the correct execution of the checklist in the operating room.
• Identify the importance of the checklist in the operating room.
• Improve its use.
• Define the place of all the actors involved in its realization.

Among the strengths of this program are:

• A scenario created in collaboration with a human factors expert and airline pilot, based on a real-life case.
• A video summary by a healthcare human factors expert and anesthesiologist on the impact of task interruptions on brain function.

The training program is structured in two parts:

PART 1: Autonomous, asynchronous

• Introduction to the training and pre-test.
• An immersive video simulation that retraces the day-to-day work of an operating room team in carrying out the checklist, from patient reception to the occurrence of an operating incident.
• A video debriefing and a summary of key points to remember.
• A HAS checklist template to download, which can be customized for tailor-made projects.
• Content to understand the impact of checklists and task interruptions, including a video on best practices and an interview with Dr. Thomas Lopes, an expert in human factors in healthcare.
• An article on the history of the checklist, a post-test, an action plan and a training evaluation.

PART 2: Group, via videoconference

• An in-depth debriefing of the video simulation with a human factors expert.
• A session dedicated to identifying gaps between individual professional practice and good checklist implementation practices.
• Identification of areas for individual and team improvement, and establishment of an action plan to strengthen teamwork.

This training is fully in line with HAS criteria for care coordination and checklist use, offering a variety of teaching methods such as video simulation, concrete cases, quizzes, and immersive role-playing. It offers continuous and final assessment to measure progress and validate learning. By mastering the checklist and reinforcing teamwork, professionals actively contribute to the continuous improvement of patient safety, in accordance with the requirements of Criterion 2.3-09.

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