Compliance with the WHO Surgical Safety Checklist: deviations and possible improvements

Area of Science:

• Patient Safety
• Surgical Workflow Analysis
• Healthcare Quality Improvement

Background:

• The World Health Organization Surgical Safety Checklist (SSC) aims to reduce communication failures and complications during surgery.
• Prior research indicates that individual values can significantly influence the implementation of safety interventions.

Purpose of the Study:

• To examine the real-world application of the SSC time-out phase.
• To identify and categorize deviations from intended checklist use to inform improvement strategies.

Main Methods:

• Video recording of 24 surgical procedures at a Swedish county hospital.
• Quantitative analysis of checklist item compliance during the time-out.
• Qualitative assessment of non-compliance reasons.

Main Results:

• Highest compliance observed for patient identification, procedure type, and antibiotics.
• Lowest compliance noted for incision site verification, theatre nurse reviews, and imaging information.
• Team member introductions occurred in only 50% of cases; surgeons and anesthesia dominated the time-out, indicating a lack of team-wide participation.

Conclusions:

• The SSC is not consistently applied as designed, with critical communication components frequently overlooked.
• The time-out often fails to function as a true team effort, suggesting a need for enhanced team engagement.
• Perceived risk and the importance of specific checklist items among personnel likely influence adherence; addressing these perceptions is crucial for improving compliance and team involvement.