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Introduction The use of surgical safety checklists (SSC) is an intervention aimed at reducing mortality and morbidity. Although the effectiveness of their use in surgery has been studied extensively, little is known about their practical use in Australian hospitals. The aim of this study was to observe and document the use of SSC in Australia. Methods This study employed direct observations of checklist use for surgical procedures by trained observers. Medical records were also audited to determine compliance with checklist use and to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records). Results Among the 11 participating hospitals, overall observed mean completion of the components of the checklist was 27%. Only one hospital used the original World Health Organization checklist. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were: correct patient (99%) and procedure (97%), whether the patient had any allergies (80%), and whether the instrument counts were performed correctly (56%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (86% completion) in comparison to the 27% observed. Conclusion This is the first study of surgical checklist use within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records.

Review question/objective The objectives of this review are to identify the effectiveness of craniectomy on morphological, functional and neurological outcomes in isolated sagittal synostosis. More specifically, the objectives are to identify: The effectiveness of craniectomy compared with cranial vault remodeling on morphological, functional and neurological outcomes in human infants with isolated non-syndromic sagittal synostosis. Inclusion criteria Types of participants This review will consider studies that include male and female human infants with clinically and/or radiologically diagnosed primary isolated sagittal synostosis. It will not look at animal studies as these have no clinical application. The review will not include studies of secondary sagittal synostosis, syndromic cases with other anomalies, or scaphocephaly from causes other than sagittal synostosis, as these may act as confounding factors in the postoperative outcomes. In studies where other sutures have been treated at least half of the cases must be isolated sagittal suture. The review will not include studies of children with mental and developmental impairments from known causes other than sagittal synostosis, as again this may influence the cognitive and developmental outcomes separately to the synostosis. The review will consider studies with mean age at time of surgery less than 24 months. This has been selected as the cut-off with the intention of preventing further deformity, the potential for complications in this period and to enable the theoretical normal reconfiguration of the growing skull. Types of intervention(s)/phenomena of interest This review will consider studies that investigate craniectomy methods, both endoscopic and non-endoscopic, compared with the control of cranial vault remodeling. The review will not consider studies that evaluate outcomes of spring cranioplasty nor non-surgical interventions, e.g. helmet therapy in the absence of surgery, as these are separate interventions within themselves. Types of outcomes This review will consider studies that include the following outcome measures: • Morphological outcomes • Functional outcomes • Neurological outcomes The primary outcome for consideration will be (skull) morphology measured by cephalic index. Cephalic index is easily and non-invasively measured and provides an objective measure that allows statistical comparison within and between samples. Cephalic index can be calculated from direct TRUNCATED AT 350 WORDS

Advances in knowledge: Handover and communication errors are prevalent in medical imaging. System-wide changes that facilitate effective communication are required. Conclusion: The handover of patients and clinical information to and from medical imaging is fraught with error, often compromising patient safety and resulting in communication of delayed or wrong diagnoses, unnecessary radiation exposure and a waste of limited resources. Corrective strategies to address safety concerns related to new information technologies, patient transfer and inadequate test result notification policies are relevant to all healthcare settings. Methods: 71 search terms, related to clinical handover and communication, were applied to 3976 incidents in the Radiology Events Register. Detailed classification and thematic analysis of a subset of incidents that involved handover or communication (n5298) were undertaken to identify the most prevalent types of error and to make recommendations about patient safety initiatives in medical imaging. Objective: To determine the type and nature of incidents occurring within medical imaging settings in Australia and identify strategies that could be engaged to reduce the risk of their re-occurrence. Results: Incidents occurred most frequently during patient preparation (34%), when requesting imaging (27%) and when communicating a diagnosis (23%). Frequent problems within each of these stages of the imaging cycle included: inadequate handover of patients (41%) or unsafe or inappropriate transfer of the patient to or from medical imaging (35%); incorrect information on the request form (52%); and delayed communication of a diagnosis (36%) or communication of a wrong diagnosis (36%). Refereed/Peer-reviewed

Background This study set out to achieve three objectives: to test the application of a context assessment tool in an acute hospital in South Australia; to use the tool to compare context in wards that had undergone an evidence implementation process with control wards; and finally to test for relationships between demographic variables (in particular experience) of nurses being studied (n = 422) with the dimensions of context. Methods The Alberta Context Tool (ACT) was administered to all nursing staff on six control and six intervention wards. A total of 217 (62%) were returned (67% from the intervention wards and 56% from control wards). Data were analysed using Stata (v9). The effect of the intervention was analysed using nested (hierarchical) analysis of variance; relationships between nurses' experience and context was examined using canonical correlation analysis. Results Results confirmed the adaptation and fit of the ACT to one acute care setting in South Australia. There was no difference in context scores between control and intervention wards. However, the tool identified significant variation between wards in many of the dimensions of context. Though significant, the relationship between nurses' experience and context was weak, suggesting that at the level of the individual nurse, few factors are related to context. Conclusions Variables operating at the level of the individual showed little relationship with context. However, the study indicated that some dimensions of context (e.g., leadership, culture) vary at the ward level, whereas others (e.g., structural and electronic resources) do not. The ACT also raised a number of interesting speculative hypotheses around the relationship between a measure of context and the capability and capacity of staff to influence it. We propose that context be considered to be dependent on ward- and hospital-level factors. Additionally, questions need to be considered about the unit of measurement of context in studies of knowledge implementation--is individual (micro), ward (meso) or hospital-level (macro) data most appropriate? The preliminary results also raise questions about how best to utilise this instrument in knowledge translation research.