Optimizing Patient Safety: Understanding and Applying Criterion 2.3-09

Patient safety is a key priority for healthcare facilities, and the implementation of a checklist has been mandatory since 2010 as part of the healthcare facility accreditation process. This requirement underscores the critical importance of verification tools in complex environments, such as aviation, where the checklist was first introduced following the 1935 crash of Boeing Flight 299, which highlighted the aircraft’s complexity and the lack of pre-flight checks. In medicine, pioneers such as Peter Pronovost and Atul Gawande have demonstrated the transformative power of these checklists, particularly in reducing infections associated with central catheters or in surgical settings.

Criterion 2.3-09: A Pillar of Practice Improvement

Healthcare facility Criterion 2.3-09 is a mandatory requirement that stipulates that "Interventional teams improve their practices by analyzing the implementation of the 'Patient Safety' checklist." This criterion, designed to enhance the safety of surgical procedures, aims to ensure the systematic verification of critical elements at every stage of patient care.

The Patient Safety Checklist allows for the verification of several essential points:

• Patient identification.
• Inspection of the surgical site.
• Inspection of devices and equipment.
• Validation of the procedure.

The French National Authority for Health (HAS) encourages healthcare professionals to adapt this checklist to make it easier to understand and implement, recognizing that healthcare professionals are best positioned to ensure improved patient safety.

By regularly analyzing how the checklist is completed, teams can:

• Identify discrepancies or areas that require attention.
• Adjust their practices.
• Improve communication among the various professionals.

This evaluation and adjustment process is essential, as it directly helps prevent errors, optimize coordination, and ensure patient safety throughout their treatment.

The evaluation criteria for professionals, as outlined in Criterion 2.3-09, are clear:

• The checklist, which may be adapted in accordance with HAS recommendations, must be systematically and thoroughly followed by the operating room and interventional teams at every stage.
• It must be carried out in the presence of the relevant professionals.
• Its implementation is monitored by the teams, including decisions on whether to proceed or not.
• The teams must implement improvement measures based on an analysis of the results of the indicators used to monitor the implementation of the checklist.

Safeteam Training: Mastering the Checklist and Strengthening Teamwork

To help healthcare professionals master these requirements, specialized training courses are available. 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 work via videoconference) is intended for anyone working in the operating room who is involved in the use of the checklist, with no prerequisites.

The learning objectives of this training are as follows:

• Master the proper use of the checklist in the operating room.
• Identify the importance of the checklist in the operating room.
• Improve its use.
• Define the role of all stakeholders involved in its creation.

Among the strengths of this program are:

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

The training program is divided into two parts:

PART 1: Independent, asynchronous

• Introduction to the training and pre-test.
• An immersive video simulation that recreates the daily routine of an operating room team as they complete the checklist, from patient admission to the occurrence of a surgical incident.
• A video debriefing and a summary of key takeaways.
• A downloadable HAS checklist template that can be customized for specific projects.
• We are pleased to provide insights into 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 Session via Videoconference

• An in-depth debriefing of the video simulation with a human factors expert.
• A session focused on identifying gaps between individual professional practice and best practices. Practical application of the checklist.
• Identifying areas for improvement at the individual and team levels, and developing an action plan to strengthen teamwork.

This training fully aligns with the HAS criteria for care coordination and checklist use, offering a variety of teaching methods such as video simulations, case studies, quizzes, and immersive role-playing. It includes ongoing and final assessments to measure progress and validate learning. By mastering the checklist and strengthening teamwork, professionals actively contribute to the continuous improvement of patient safety, in accordance with the requirements of Criterion 2.3-09.

‍