***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND We aim ed to improve the quality and safety of  h and over of patients from surgery to intensive care using the analogy of a Formula 1 pit stop and expertise from aviation . METHODS A prospect i ve intervention study measured the change in performance before and after the implementation of a new h and over protocol that was developed through detailed discussion s with a Formula 1 racing team and aviation training captains . Fifty ( 23 before and 27 after ) postsurgery patient h and overs were observed .  Technical errors and information omissions were measured using  checklists , and  teamwork  was  scored  using a Likert scale . Duration of the h and over was also measured . RESULTS The mean number of technical errors was reduced from 5.42 ( 95 % CI + /-1.24 ) to 3.15 ( 95 % CI + /-0.71 ) , the mean number of information h and over omissions was reduced from 2.09 ( 95 % CI + /-1.14 ) to 1.07 ( 95 % CI + /-0.55 ) , and duration of h and over was reduced from 10.8 min ( 95 % CI + /-1.6 ) to 9.4 min ( 95 % CI + /-1.29 ) . Nine out of twenty-three ( 39 % ) precondition patients had more than one error in both technical and information h and over prior to the new protocol , compared with three out of twnety-seven ( 11.5 % ) with the new h and over . Regression analysis showed that the number of technical errors were significantly reduced with the new h and over ( t = -3.63 , P < 0.001 ) , and an interaction suggested that teamwork ( t = 3.04 , P = 0.004 ) had a different effect with the new h and over protocol . CONCLUSIONS The introduction of the new h and over protocol lead to improvements in all aspects of the h and over . Expertise from other industries can be extrapolated to improve patient safety , and in particular , areas of medicine involving the h and over of patients or information Objective To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies . Design Retrospective medical record review of hospital admissions during 2005 in eight countries . Setting Ministries of Health of Egypt , Jordan , Kenya , Morocco , Tunisia , Sudan , South Africa and Yemen ; the World Health Organisation ( WHO ) Eastern Mediterranean and African Regions ( EMRO and AFRO ) , and WHO Patient Safety . Participants Convenience sample of 26 hospitals from which 15 548 patient records were r and omly sample d. Main outcome measures Two stage screening . Initial screening based on 18 explicit criteria . Records that screened positive were then review ed by a senior physician for determination of adverse event , its preventability , and the result ing disability . Results Of the 15 548 records review ed , 8.2 % showed at least one adverse event , with a range of 2.5 % to 18.4 % per country . Of these events , 83 % were judged to be preventable , while about 30 % were associated with death of the patient . About 34 % adverse events were from therapeutic errors in relatively non-complex clinical situations . Inadequate training and supervision of clinical staff or the failure to follow policies or protocol s contributed to most events . Conclusions Unsafe patient care represents a serious and considerable danger to patients in the hospitals that were studied , and hence should be a high priority public health problem . Many other developing and transitional economies will probably share similar rates of harm and similar contributory factors . The convenience sampling of hospitals might limit the interpretation of results , but the identified adverse event rates show an estimate that should stimulate and facilitate the urgent institution of appropriate remedial action and also to trigger more research . Prevention of these adverse events will be complex and involves improving basic clinical processes and does not simply depend on the provision of more re sources BACKGROUND Surgery has become an integral part of global health care , with an estimated 234 million operations performed yearly . Surgical complications are common and often preventable . We hypothesized that a program to implement a 19-item surgical safety checklist design ed to improve team communication and consistency of care would reduce complications and deaths associated with surgery . METHODS Between October 2007 and September 2008 , eight hospitals in eight cities ( Toronto , Canada ; New Delhi , India ; Amman , Jordan ; Auckl and , New Zeal and ; Manila , Philippines ; Ifakara , Tanzania ; London , Engl and ; and Seattle , WA ) representing a variety of economic circumstances and diverse population s of patients participated in the World Health Organization 's Safe Surgery Saves Lives program . We prospect ively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery . We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist . The primary end point was the rate of complications , including death , during hospitalization within the first 30 days after the operation . RESULTS The rate of death was 1.5 % before the checklist was introduced and declined to 0.8 % afterward ( P=0.003 ) . Inpatient complications occurred in 11.0 % of patients at baseline and in 7.0 % after introduction of the checklist ( P<0.001 ) . CONCLUSIONS Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals Objective Implementation of a surgical checklist depends on many organisational factors and on socio-cultural patterns . The objective of this study was to identify barriers to effective implementation of a surgical checklist and to develop a best use strategy . Setting 18 cancer centres in France . Design The authors first assessed use compliance and completeness rates of the  surgical checklist  on a r and om sample of 80 surgical procedures performed under general or loco-regional anaesthesia in each of the 18 centres . They then developed a typology of the organisational and cultural barriers to effective checklist implementation and defined each barrier 's contents using data from collective and semi-structured individual interviews of key staff , the results of an email question naire sent to the 18 centres , and direct observations over 20 h in two centres . Results The study consisted of 1440 surgical procedures , 1299 checklists , and 28 578 items . The mean compliance rate was 90.2 % ( 0 , 100 ) . The mean completion rate was 61 % ( 0 , 84 ) . 11 barriers to effective checklist implementation were identified . Their incidence varied widely across centres . The main barriers were duplication of items within existing checklists ( 16/18 centres ) , poor communication between surgeon and anaesthetist ( 10/18 ) , time spent completing the checklist for no perceived benefit , and lack of underst and ing and timing of item checks ( 9/18 ) , ambiguity ( 8/18 ) , unaccounted risks ( 7/18 ) and a time-honoured hierarchy ( 6/18 ) . Conclusions Several of the barriers to the successful implementation of the surgical checklist depended on organisational and cultural factors within each centre . The authors propose a strategy for change for checklist design , use and assessment , which could be used to construct a feedback loop for local team organisation and national initiatives Objective : To assess whether implementation of a 19-item World Health Organization ( WHO ) Surgical Safety Checklist in urgent surgical cases would improve compliance with basic st and ards of care and reduce rates of deaths and complications . Background : Use of the WHO Surgical Safety Checklist has been shown to be associated with significant reductions in complications and deaths . Before evaluation of this safety tool , concern was raised about whether its use would be practical or beneficial during urgent surgical procedures . Methods : We prospect ively collected clinical process and outcome data for 1750 consecutively enrolled patients 16 years of age or older undergoing urgent noncardiac surgery before and after introduction of the WHO Surgical Safety Checklist in 8 diverse hospitals around the world ; 842 underwent urgent surgery — defined as an operation required within 24 hours of assessment to be beneficial — before introduction of the checklist and 908 after introduction of the checklist . The primary end point was the rate of complications , including death , during hospitalization up to 30 days following surgery . Results : The complication rate was 18.4 % ( n = 151 ) at baseline and 11.7 % ( n = 102 ) after the checklist was introduced ( P = 0.0001 ) . Death rates dropped from 3.7 % to 1.4 % following checklist introduction ( P = 0.0067 ) . Adherence to 6 measured safety steps improved from 18.6 % to 50.7 % ( P < 0.0001 ) . Conclusions : Implementation of the checklist was associated with a greater than one-third reduction in complications among adult patients undergoing urgent noncardiac surgery in a diverse group of hospitals . Use of the WHO Surgical Safety Checklist in urgent operations is feasible and should be considered Background Positive changes in safety culture have been hypothesized to be one of the mechanisms behind the reduction in mortality and morbidity after the introduction of the World Health Organization 's Surgical Safety Checklist ( SSC ) . We aim ed to study the checklist effects on safety culture perceptions in operating theatre personnel using a prospect i ve controlled intervention design at a single Norwegian university hospital . Methods We conducted a study with pre- and post-intervention surveys using the intervention and control groups . The primary outcome was the effects of the Norwegian version of the SSC on safety culture perceptions . Safety culture was measured using the vali date d Norwegian version of the Hospital Survey on Patient Safety Culture . Descriptive characteristics of operating theatre personnel and checklist compliance data were also recorded . A mixed linear regression model was used to assess changes in safety culture . Results The  response rate was 61 % ( 349/575 ) at baseline and 51 % ( 292/569 ) post-intervention . Checklist compliance ranged from 77 % to 85 % . We found significant positive changes in the checklist intervention group for the culture factors ‘ frequency of events reported ’ and ‘ adequate staffing ’ with regression coefficients at −0.25 [ 95 % confidence interval ( CI ) , −0.47 to −0.07 ] and 0.21 ( 95 % CI , 0.07–0.35 ) , respectively . Overall , the intervention group reported significantly more positive culture scores — including at baseline . Conclusions Implementation of the SSC had rather limited impact on the safety culture within this hospital BACKGROUND Preventable deaths due to errors in trauma patients with otherwise survivable injuries account for up to 10 % of fatalities in Level I trauma centers , 50 % of these errors occur in the intensive care unit ( ICU ) . The root cause of 67 % of the Joint Commission sentinel events is communication errors . The objective is ( 1 ) to study how critical information de grade s and how it is lost over 24 hours and ( 2 ) to determine whether a structured checklist for ICU h and offs prevents information loss . METHODS Prospect i ve cohort study of trauma and surgical ICU teams observed with and without use of the checklist . An observational period ( control group ) was followed by a didactic session on the science and use of a checklist ( study group ) , which was used for patient management and h and offs . Information was tracked for a 24-hour period and all h and offs . Comparisons use chi or Fisher 's exact test and a p value < 0.05 was defined as significant . RESULTS Three hundred and thirty-two patient ICU days were observed ( 119 control , 213 study ) and 689 patient care items ( 303 control , 386 study ) were followed . Seventy-five ( 10.9 % ) items were lost over 24 hours ; 61 of 303 ( 20.1 % ) without checklist and 14 of 386 ( 3.6 % ) with checklist ( p < 0.0001 ) . Critical laboratory values and test results were the most frequent lost items ( 36.1 % control vs. 4.5 % study p < 0.0001 ) . Six of 75 ( 8.1 % ) items were correctly ordered but not carried out by ICU nursing staff -- all caught and corrected with checklist use . CONCLUSION Critical information is de grade d over 24 hours in the ICU . A structured checklist significantly reduces patient errors due to lost information and communication lapses between trauma ICU team members at h and offs of care OBJECTIVES Perioperative h and offs are a particularly high-risk period given patients ' postprocedural physiology , their physical transport through the hospital , and the triad transfer of personnel , information , and technology . The authors piloted a new perioperative h and off process to guide patient transfers from the cardiac operating room ( OR ) to the cardiac surgical intensive care unit ( CSICU ) . The aim of the study was to evaluate the impact of a st and ardized h and off process on patient care and provider satisfaction . DESIGN A prospect i ve , unblinded intervention study . SETTING A CSICU in a teaching hospital . PARTICIPANTS Two hundred thirty-eight health care practitioners during the transfer of care of 60 patients . INTERVENTIONS The implementation of a st and ardized h and off protocol and checklist . MEASUREMENTS AND MAIN RESULTS After the protocol 's implementation , the presence of all h and off core team members at the bedside increased from 0 % at baseline to 68 % after intervention . The percentage of missed information in the surgery report decreased from 26 % to 16 % ( p = 0.03 ) , but the percentage of missed information in the anesthesia report showed no significant change (  
    Output:
    
The main findings were improved communication , reduced adverse events , better adherence to st and ard operating procedures , and reduced morbidity and mortality .
None of the included studies reported decreased patient safety or quality after introducing safety checklists .
CONCLUSION Safety checklists appear to be effective tools for improving patient safety in various clinical setting s by strengthening compliance with guidelines , improving human factors , reducing the incidence of adverse events , and decreasing mortality and morbidity .
None of the included studies reported negative effects on safety