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

Background Intra- and postoperative adverse events (AEs) are devastating to patients and costly for healthcare systems. In 2008, the World Health Organization Surgical Safety Checklist was introduced to minimize 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 AEs 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 (R) for Better Outcomes in Surgery) is currently being conducted in Switzerland. This project evaluates the effectiveness and implementation of systematic recording of intraoperative AEs using ClassIntra (R) (a generic classification system for intraoperative AEs) and an interdisciplinary discussion during the sign-out. The current study, conducted in the preimplementation phase of CIBOSurg, aims to assess existing practices and determinants concerning the future implementation of systematic recording of intraoperative AEs, perceptions surrounding ClassIntra (R), 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 semistructured 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 AEs are not being systematically recorded and discussed, despite recognition of their importance. Most interviewees considered the application and implementation of ClassIntra (R) to be feasible and were convinced that a systematic recording of intraoperative AEs and interdisciplinary discussion among 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 AEs 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 AEs and improve sign-out performance. Future implementation of ClassIntra (R) is generally perceived positively. The findings address a critical gap in surgical safety practice and provide a basis for developing multifaceted implementation strategies.