Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical...

Area of Science:

• Surgical Safety
• Healthcare Quality Improvement
• Patient Outcomes

Background:

• Unanswered questions persist regarding the impact of surgical checklists on patient outcomes, particularly concerning varying case complexity and implementation extent.
• The World Health Organization (WHO) surgical checklist is a widely adopted tool aimed at improving patient safety during surgical procedures.

Purpose of the Study:

• To evaluate the impact of WHO surgical checklist compliance on risk-adjusted clinical outcomes.
• To determine the influence of individual checklist components (Sign-in, Time-out, Sign-out) on patient outcomes.

Main Methods:

• A retrospective analysis of 6714 surgical admissions across 5 hospitals from March 2010 to June 2011.
• Data collection included checklist completion status (full/partial) and patient outcomes, with the primary endpoint being any complication or mortality before hospital discharge.
• Multilevel modeling was employed to assess the association between checklist completion and adverse events.

Main Results:

• While 96.7% of cases had at least one checklist component completed, only 62.1% were fully completed.
• Full checklist completion was associated with a significant reduction in postoperative complications (16.9% vs. 11.2%), but not mortality.
• Completion of all three checklist components demonstrated the most significant impact (odds ratio = 0.57).

Conclusions:

• Implementation of the WHO surgical checklist is linked to reduced case-mix-adjusted postoperative complications.
• Achieving full completion of all checklist components is crucial for maximizing its positive impact on surgical safety and patient care.
• Health policies should promote full checklist completion to enhance surgical quality and safety.