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Chinese Patients' Attitudes Toward the WHO Surgical Safety Checklist
Yuzhang Wang1, Yanhe Wang, Ngwayi James Reeves Mbori
1Author Affiliations: Department of Rehabilitation Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China (Ms Yuzhang Wang); Department of Orthopaedic Surgery, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, China (Dr Yanhe Wang); Orthopaedic Department, Ipswich Hospital, Ipswich, United Kingdom (Dr Mbori); Department of Trauma and Bone Tumour, Tongji Hospital, Tongji University, Shanghai, China (Dr Chen); Department of Orthopaedic Surgery, Ansteel Group Hospital, Anshan, China (Dr Li); Department of Spine Surgery, Luohe Central Hospital, Luohe Medical College, Luohe, China (Dr Hu); Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China (Dr Tan); and Department of Orthopaedic Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China (Prof Porter).
Background And Objectives:
Strategies to reduce adverse events have mainly focused on systems of care and professional behavior despite a growing interest in involving patients in safety initiatives. Only some studies were published in developing countries. This study sought to clarify the patients' views on the surgical safety checklist in China.
Methods:
We developed a research-based patient questionnaire and delivered it through a ubiquitous social media platform. The survey was sent to patients over 12 weeks from May to July 2020. Responses were accepted up to the end of July 2020. This survey was conducted at 5 Level 3 hospitals in 4 provinces (Beijing, Shandong, Liaoning, and Henan). Descriptive statistics (frequencies and percentages) were calculated to demonstrate the overall quality of checklist use. Multivariate linear regression was utilized to assess the predictive factors for respondents' views on the risk of an adverse event. Multivariate ordinal logistic regression, with respondents' characteristics as covariates, predicted attitude toward the WHO Surgical Safety Checklist. Adjusted odds ratios with 95% confidence intervals were calculated.
Results:
A total of 475 patients at 5 centers responded. Previous adverse medical events occurred more (26.7%) than generally reported. For surgical patients, the estimates of adverse-event risk in the hospital were almost entirely due to the perceived risks of surgery itself. Lower risk estimates were generated by patients who had experienced more surgery before (adjusted odds ratio = -0.429, 95% confidence interval: -0.752 to 0.107, P < .01). Compared with other studies, the proportion of patients with a positive perception of the checklist was lower. However, more than half (53.3%) thought the checklist would improve communication between staff. More patients than elsewhere were anxious about hearing repetitive confirmation before surgery. In keeping with more rigid role expectations in China, more patients preferred a doctor taking charge of the checklist (37.3%). Chinese patients had a more positive view of the patient's role in surgical safety improvement.
Conclusions:
Less than half of Chinese patients hold positive views on implementing the surgical safety checklist despite a higher perception of the risk of adverse surgical events than elsewhere. Patients would like to become more actively involved in surgical safety improvement. We suggest greater patient involvement during the implementation of the WHO Surgical Checklist, fostering a more supportive and collaborative environment in the future.