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Validation of a Norwegian version of SURgical PAtient Safety System (SURPASS) in combination with the World Health Organizations’ Surgical Safety Checklist (WHO SSC)
  1. Anette Storesund1,2,
  2. Arvid Steinar Haugen1,
  3. Hilde Valen Wæhle3,4,
  4. Rupavathana Mahesparan5,
  5. Marja A Boermeester6,
  6. Monica Wammen Nortvedt7,8,
  7. Eirik Søfteland1,2
  1. 1 Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
  2. 2 Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
  3. 3 Department of Research and Development, Haukeland University Hospital, Bergen, Norway
  4. 4 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
  5. 5 Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
  6. 6 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
  7. 7 Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
  8. 8 Accident and Emergency Department, City of Bergen, Bergen, Norway
  1. Correspondence to MCCN (Hons) Anette Storesund; anette.storesund{at}


Introduction Surgical safety checklists may contribute to reduction of complications and mortality. The WHO’s Surgical Safety Checklist (WHO SSC) could prevent incidents in operating theatres, but errors also occur before and after surgery. The SURgical PAtient Safety System (SURPASS) is designed to intercept errors with use of checklists throughout the surgical pathway.

Objective We aimed to validate a Norwegian version of the SURPASS’ preoperative and postoperative checklists for use in combination with the already established Sign In, Time Out and Sign Out parts of the WHO SSC.

Methods and materials The validation of the SURPASS checklists content followed WHOs recommended guidelines. The process consisted of six steps: forward translation; testing the content; focus groups; expert panels; back translation; and approval of the final version. Qualitative content analysis was used to identify codes and categories for adaption of the SURPASS checklist items throughout Norwegian surgical care. Content validity index (CVI) was used by expert panels to score the relevance of each checklist item. The study was carried out in a neurosurgical ward in a large tertiary teaching hospital in Norway.

Results Testing the preoperative and postoperative SURPASS checklists was performed in 29 neurosurgical procedures. This involved all professional groups in the entire surgical patient care pathway. Eight clinical focus groups revealed two main categories: ‘Adapt the wording to fit clinical practice’ and ‘The checklist items challenge existing workflow’. Interprofessional scoring of the content validity of the checklists reached >80% for all the SURPASS checklists.

Conclusions The first version of the SURPASS checklists combined with the WHO SSC was validated for use in Norwegian surgical care with face validity confirmed and CVI >0.80%.

Trial registration number NCT01872195.

  • patient safety
  • checklists
  • surgery
  • quality improvement
  • transitions in care

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  • Patient consent for publication Not required.

  • Contributors AS, ASH, MAB and ES contributed with the conception and design of the study. AS, ASH, HVW, RM and ES: acquisition of data. AS, ASH, HVW, MWN, MAB and ES: analysis and interpretation of data. AS drafted the article and designed the figures. ASH, MWN and ES supervised the project. AS is the overall content guarantor for the manuscript.

  • Funding AS was supported by a research grant from the Western Norway Regional Health Authority Trust, the Patient Safety Program (grant number HV1173) and Norwegian Nurses Organisation (grant number 15/0023). ASH was supported by a postdoctoral fellow research grant from the Western Norway Regional Health Authority Trust, the Patient Safety Program (grant number HV1172). HVW was supported by a research grant from the Western Norway Regional Health Authority Trust, the Patient Safety Program (grant number HV1174).

  • Disclaimer The funders have not been involved in the study design, data collection, analysis, interpretation of data, writing of the report or to the decision to submit the paper for submission.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Western Norway Regional Ethical Research Committee (2012/560/REK West).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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