Understanding WHO surgical checklist implementation: tricks and pitfalls. An observational study

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Surgical process analysis

Background:

• The surgical safety checklist (SSC) is crucial for patient safety.
• Assessing the reliability of SSC implementation data is essential.
• Identifying factors influencing actual SSC use is key.

Purpose of the Study:

• To evaluate the reliability of surgical safety checklist (SSC) implementation data.
• To determine factors affecting the actual use of the SSC in surgical settings.

Main Methods:

• Retrospective record review across nine Spanish hospitals.
• Direct observation study with surgical team attitude surveys.
• Comparison of retrospective and concurrent surgical intervention data.

Main Results:

• Retrospective data showed 83.1% SSC presence, but only 28.4% fully completed.
• Direct observation revealed unreliable recorded compliance (κ < 0.13) and significant over-registration.
• Surgeon attitude (OR 12.8) and electronic format use (negatively impacting actual compliance) were key factors.

Conclusions:

• Recorded SSC compliance is often unreliable and inflated compared to actual use.
• Positive surgeon attitude is a significant driver of actual SSC compliance.
• Effective SSC implementation is a complex adaptive process, not merely a mandatory task.