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Mind the Gap: Reported Versus Observed Surgical Safety Checklist Time-Out Adherence in the Hybrid Operating Room.

Nicholas Rennie1, Gilles Soenens1, Ida Meyns2

  • 1Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.

World Journal of Surgery
|February 19, 2026
PubMed
Summary

Real-world adherence to the WHO Surgical Safety Checklist (SSC) time-out in endovascular surgery is significantly lower than reported. Video analysis revealed critical gaps, emphasizing the need for better assessment and implementation strategies for surgical safety.

Keywords:
endovascular surgeryhybrid operating roompatient safetysurgical safety checklist

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Area of Science:

  • Endovascular Surgery
  • Patient Safety
  • Surgical Quality Improvement

Background:

  • Endovascular surgery demands stringent safety protocols.
  • The WHO Surgical Safety Checklist (SSC) aims to reduce surgical risks, but recent adherence data are mixed.
  • Assessing real-world adherence in hybrid ORs is crucial.

Purpose of the Study:

  • To observe real-world adherence to the WHO SSC time-out phase in a hybrid OR.
  • To evaluate the effectiveness of the Checklist Performance Observation for ImprovemeNT (CheckPOINT) tool.

Main Methods:

  • Retrospective observational study of endovascular procedures (May 2021-Dec 2022).
  • Transition from paper to electronic SSCs in October 2021.
  • Video recording via OR Black Box and time-out evaluation using CheckPOINT.

Main Results:

  • Time-out initiated in 87.7% of procedures; reported completion was 95.5% vs. observed 46.8%.
  • Observed adherence significantly lower than reported for most items, except 'Patient Name'.
  • Experienced surgeons showed lower initiation and completion rates; CheckPOINT engagement was low.

Conclusions:

  • Video observation highlights substantial discrepancies between reported and actual SSC adherence.
  • Improved SSC assessment and implementation are necessary.
  • Combining video recording with tools like CheckPOINT can drive data-driven quality improvement.