SC army hospital integrates surgical checklist into high-tech OR

Team-based Safe Surgery program fits with Moncrief's military protocol.

Moncrief Army Community Hospital is located on one of the largest military training bases in the country - Fort Jackson,SC - and serves more than 48,000 Initial Entry Training Soldiers (soldiers going through basic training) a year. The hospital staff also cares for thousands of military retirees, active duty soldiers, and their family members.

In addition, the hospital has a sharing agreement with the U.S. Department of Veterans Affairs (VA). For instance, a VA surgeon is able to operate in Moncrief’s operating room to expedite a patient’s surgery.

To help ensure the best possible patient outcomes, the surgical team recently started using an adapted version of the Safe Surgery 2015: South Carolina checklist. The use of a checklist during surgery can save lives, prevent complications and lower costs.

The program was developed by Atul Gawande, MD, MPH and the Harvard School of Public Health in partnership with SCHA to provide a safe surgical environment for every patient in the state, every time.

“Change is difficult, but through active and assertive leadership it can and does happen,” said Major Harold Williams, who has been Chief of Peri-Operative Nursing Services at Moncrief for the last two years. “Everyone wants and benefits from the camaraderie that comes from working together. When we understand what our neighbors are doing around us, we can do better for our patients.”

According to Williams, it wasn’t much of a stretch to implement the checklist program with Moncrief’s environment and workflows.

“We were already using similar procedures, so it was a great fit,” he said. (Most military installations already use the Agency for Healthcare Research and Quality’s patient safety communication improvement program Team STEPPS for trauma training).

The Moncrief staff, military, Department of Defense civilians and contractors, were educated about the improvements the checklist would provide for the patients. This made the implementation successful. Williams stressed the need to create buy-in from physicians when implementing a new procedure like the checklist. “They need to know why it will make a sustainable difference.”

The Safe Surgery 2015: South Carolina program appealed to him because it incorporates information gathered from hospital surgical teams – the “boots on the ground.”

Moncrief recently installed new state of the art equipment in their operating room, including Stryker monitors arranged in a “hanging tower” system. The surgical checklist briefing is embedded into the computer’s program and appears on every monitor in the room (which helps get everyone present to stop what they’re doing and look at one of the screens). The program even automatically mutes any music that might be playing. None of the monitor screens can be changed until each element of the list has been checked off. 

The patient’s electronic medical record (EMR) is also integrated into the checklist program on the circulating nurse’s computer screen. 

  (Above) Captain Keyona Nelson explains the innovative Moncrief monitor system during a Safe Surgery 2015 panel discussion.

“I could not be more delighted with how Major Williams and his teams have integrated the South Carolina surgical safety checklist template into their existing processes,” said Ashley Kay Childers, PhD, CPHQ. Childers is a member of the South Carolina Hospital Association’s Quality and Patient Safety team and professor of Industrial Engineering at Clemson University.

 “The Army has protocol in place for team-based discussions, but the Moncrief team has been able to enhance and support it by incorporating the checklist briefing into their electronic system in an innovative way.”

The Moncrief team has started working on a post-surgery debriefing protocol (to talk about what went right, what went wrong and any concerns) as a result of a site visit from Childers, who has been observing procedures and talking with hospital surgical teams about their checklist use across the state.

Williams welcomes further collaboration with other South Carolina hospitals and providers. “There are smart people out there. We can help improve patient care across the state by sharing our ideas and our knowledge.”