Clinical audit of pre-procedural checklists in an equine referral hospital.
Authors: Beeston Thomas J, Duncan Juliet C, Pollock Patrick J
Journal: Equine veterinary journal
Summary
# Editorial Summary: Pre-procedural Checklist Compliance in Equine Referral Practice Surgical safety checklists have proven their worth in human medicine by reducing post-operative complications and mortality, yet their effectiveness depends entirely on consistent, thorough use—a challenge that extends equally to equine practice. Researchers at a large multi-disciplinary equine referral hospital conducted a full-cycle clinical audit examining 148 pre-procedural checklists (each containing 23 sub-sections) for completion rates, then implemented a series of targeted interventions including checklist redesign, staff education, email reminders, and appointment of senior champions before re-auditing 30 additional cases. Initial audit results revealed concerning gaps, with completion rates across different sections ranging from only 9% to 89% (median 64%), though the re-audit following interventions demonstrated dramatic improvement to 80–100% (median 93%), with the sign-out section remaining the most vulnerable to incomplete documentation. For equine professionals involved in referral practice, these findings underscore that checklist compliance is highly responsive to organisational culture change and practical redesign—suggesting that audit cycles, staff engagement, and clear institutional policy (such as mandatory upload to medical records) represent worthwhile investments in patient safety. Whilst the re-audit's smaller sample size and staff awareness of auditing may have temporarily inflated compliance figures, the magnitude of improvement indicates that structured interventions can meaningfully embed safety practices into daily practice routines.
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Practical Takeaways
- •Implement systematic pre-procedural checklists in your hospital and conduct regular audits to identify compliance gaps—this simple practice can significantly improve surgical safety culture
- •Engage end-users in checklist design and recruit senior staff champions; this collaborative approach was key to improving compliance from 64% to 93% completion rates
- •Make checklist integration into medical records a mandatory policy and send regular reminders to staff—these reinforcement strategies help sustain improved compliance beyond the audit period
Key Findings
- •Initial audit showed median checklist completion rate of 64% (range 9-89%) across 23 subsections in 148 checklists
- •Re-audit after interventions demonstrated median completion rate improved to 93% (range 80-100%) in 30 checklists
- •Sign-out section was the most frequently incomplete subsection in both audits
- •Multi-faceted interventions including checklist redesign, staff education, reminders, and champion recruitment were effective in improving compliance