Improving Surgical Safety Through Checklist Compliance: Lessons From a Clinical Audit in a Teaching Hospital

Area of Science:

• Global Health
• Surgical Safety
• Healthcare Quality Improvement

Background:

• The World Health Organization Surgical Safety Checklist (SSC) is crucial for improving perioperative safety.
• Inconsistent compliance with the SSC, particularly in resource-limited settings, poses a significant risk.
• This study addresses the need to assess SSC implementation and identify barriers in Sudan.

Purpose of the Study:

• To evaluate compliance with the WHO SSC at Omdurman Teaching Hospital.
• To identify barriers hindering effective SSC implementation.
• To assess the impact of an educational intervention on SSC compliance.

Main Methods:

• An observational clinical audit involving 100 operations (50 baseline, 50 post-intervention).
• Data collection using a structured tool based on WHO SSC phases (Sign-In, Time-Out, Sign-Out).
• Implementation of an educational intervention (seminars, posters, reminders) between audit cycles.

Main Results:

• Baseline SSC compliance was suboptimal, with significant improvements post-intervention (e.g., Sign-In: 60% to 86%).
• Documentation and patient board completion rates increased substantially after the intervention.
• Verbalization of checklist items remained a challenge, and staff cited lack of awareness and workload as key barriers.

Conclusions:

• A simple educational intervention can measurably improve WHO SSC compliance in a limited-resource setting.
• Sustained adherence requires addressing barriers such as weak verbalization, lack of awareness, and perceived workload.
• Ongoing training, leadership support, and cultural change are essential for strengthening surgical safety in Sudan.