Enhancing Surgical Safety: Evaluating Compliance With the WHO Checklist in a Peripheral Hospital in Sri Lanka

Background The World Health Organization (WHO) Surgical Safety Checklist is utilised globally to enhance communication and teamwork, ensuring patient safety in surgeries and reducing complications and mortality. Despite its efficacy, compliance with the checklist may be variable, particularly in resource-limited settings. This audit evaluated the adherence to the WHO Surgical Safety Checklist in the surgical theatre of Base Hospital Thambuththegama, Sri Lanka, to identify the gaps and areas for improvement. Methods A prospective audit assessed 102 surgical cases over three weeks, including elective and non-elective procedures. Data collection involved real-time observation of checklist use and assessment of staff participation. Compliance was evaluated based on checklist attachment, completion, and timing, while staff participation rates were analysed across roles. Results In 87.25% of cases, the checklist was attached to the bed head ticket (BHT). Fully completed checklists were observed in only 34.31% of cases, with just 13.73% completed at the correct time. Staff participation was highest among anaesthetists (90.5%) and house officers (88.1%) but significantly lower among consultants (7.1%). Key barriers included incomplete sections, incorrect timing, and inconsistent participation from senior staff. Conclusions The audit highlights critical gaps in compliance with the WHO Surgical Safety Checklist, emphasising the need for targeted interventions. These include staff training, real-time monitoring, and enhanced accountability. Addressing these gaps can significantly improve surgical safety and patient outcomes. A re-audit is planned to evaluate the impact of the proposed changes.