Systematic recording and discussion of intraoperative adverse events using ClassIntra: Results of a qualitative context analysis before implementation

Background Intra- and postoperative adverse events are devastating to patients and costly for healthcare systems. In 2008, the World Health Organization Surgical Safety Checklist was introduced to minimise morbidity and mortality and to enhance team performance. It consists of three parts whereof the third part, the sign-out at the end of surgery, is generally performed poorly. Addressing intraoperative adverse events and discussion of the consecutive postoperative management should take place during this often-omitted sign-out. To address this issue, a national, multicentre quality improvement project (CIBOSurg – ClassIntra® for Better Outcomes in Surgery) is currently being conducted in Switzerland. This project evaluates the effectiveness and implementation of systematic recording of intraoperative adverse events using ClassIntra® (a generic classification system for intraoperative adverse events) and an interdisciplinary discussion during the sign-out. The current study, conducted in the pre-implementation phase of CIBOSurg, aims to assess existing practices and determinants concerning the future implementation of systematic recording of intraoperative adverse events, perceptions surrounding ClassIntra®, and its implementation during sign-out. Methods A qualitative context analysis was conducted across eight hospitals in Switzerland and one in the Netherlands. Nearly 100 semi-structured interviews were conducted with interdisciplinary staff from different surgical disciplines. Data were analysed using rapid analysis and concept-structuring qualitative content analysis guided by the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change. Results Findings indicate that the sign-out is not yet implemented consistently at every participating hospital. Currently, intraoperative adverse events are not being systematically recorded and discussed, despite recognition of their importance. Most interviewees considered the application and implementation of ClassIntra® to be feasible and were convinced that a systematic recording of intraoperative adverse events and interdisciplinary discussion amongst the operative team during sign-out is particularly useful for learning and postoperative patient care. Several barriers and facilitators to the successful recording and discussion of intraoperative adverse events were identified. Conclusion The study results provide important information about current practices, while also generating insights on how to better discuss and systematically record intraoperative adverse events and improve sign-out performance. Future implementation of ClassIntra® is generally perceived positively. The findings address a critical gap in surgical safety practice and provide a basis for developing multifaceted implementation strategies.