Phased implementation of surgical safety care bundle in a multispecialty, tertiary care teaching hospital: a quality...

'Safe surgery saves lives' initiative by the WHO consists of measures focussed on improving surgical safety. Healthcare institutions across the globe are encouraged to identify the lacunae in surgical safety and adopt these initiatives to suit the local practices and traditions.

A few never events and near misses prompted our institution to create a surgical care safety bundle to improve perioperative patient safety. The surgical care bundle focused on improving the usage of surgical safety checklist (SSCL), surgical consents, surgical site marking (SSM) and sponge count in a phased manner. Baseline audits were conducted for each of the above components at different time points and measures were introduced to improve compliance.

The baseline usage of SSCL in 2010 was 65% that improved to 70% in 2014, 86% in 2016 and 97% in 2019. The availability of general surgical consents improved from 56% in 2010 to 70% in 2015. With the introduction of specialised surgical consents in 2019, the compliance improved significantly to 99%. SSM was added to the project in 2017, improved from baseline 74% to 95% in 2019 and continues to remain above 90%. Sponge count documentation has been below 80% in 2010 and was implemented as a part of the safe surgery protocol in 2019 after which compliance significantly improved and stayed above 90%. Good compliance with the usage of checklists and improved the safety culture was demonstrated by increased reporting of near miss events. Never events have not occurred after introduction of all components of surgical safety in 2019.

Phased implementation of surgical care safety bundles, audits and reaudits, repeated educational measures and a slow yet steady process of interventions has markedly improved the safety culture and surgical safety in a larger teaching hospital of a developing country.