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Writing's on the wall: improving the WHO Surgical Safety Checklist.

Claire Cushley1, Tom Knight2, Helen Murray3

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Implementing a wall-mounted surgical safety checklist significantly boosted team compliance and engagement, exceeding targets. This initiative improved patient safety protocols in surgical settings.

Keywords:
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Area of Science:

  • Healthcare Management
  • Patient Safety
  • Surgical Operations

Background:

  • The World Health Organization (WHO) Surgical Safety Checklist is vital for enhancing patient safety, teamwork, and communication in operating rooms.
  • Mandated in NHS hospitals since 2009, the checklist requires adaptation for local settings.
  • Gloucestershire Hospitals NHS Foundation Trust adapted the WHO checklist and initiated a review in 2018 to improve compliance and engagement.

Purpose of the Study:

  • To achieve 90% compliance and engagement with the adapted WHO Surgical Safety Checklist by April 2019.
  • To evaluate the effectiveness of implementing a wall-mounted checklist and refining checklist procedures.

Main Methods:

  • A prospective observational audit and online survey were conducted in April 2018 to assess baseline compliance and engagement.
  • The study proposed transitioning from a paper-based to a wall-mounted checklist, refining items, and adjusting the timing of 'Time Out' to immediately precede skin incision.
  • The new checklist was introduced in September 2018, followed by reaudits in September and December 2018 to measure improvements.

Main Results:

  • Initial compliance was 55% for 'Sign In' and 91% for 'Time Out', with 58% team engagement.
  • Post-implementation, 'Sign In' compliance rose to 91% and 'Time Out' to 94%, with 100% team engagement.
  • Further reaudits showed 'Sign In' compliance reached 99% and 'Time Out' 100%, with sustained 100% engagement.

Conclusions:

  • The project successfully met and exceeded its aim of achieving 90% compliance and engagement.
  • The adapted, wall-mounted WHO Surgical Safety Checklist is now standard practice across all theatres at the Trust since April 2019.
  • The findings demonstrate the effectiveness of targeted interventions in improving adherence to critical patient safety protocols.