Compliance and surgical team perceptions of WHO Surgical Safety Checklist: systematic review

This systematic review aimed to assess surgical safety checklist compliance and evaluate surgical team perceptions and attitudes, post-checklist implementation in the operating room. The World Health Organization (WHO) surgical safety checklist (SSC) has decreased complications and mortality. However, it is unclear whether this reduction is influenced by the vicarious enhancement in teamwork, communication, and staff awareness established by SSC implementation. The preferred reporting items for systematic reviews and meta-analyses model of review guided a search across MEDLINE, PubMed, and Embase databases. English-language studies using any adapted form of the WHO-SSC in operating rooms were reviewed by abstract and full text. Twenty-six studies, 13 assessing SSC compliance and 13 investigating surgical team perceptions of SSC, were evaluated. Compliance studies showed a checklist initiation rate of >90%, but actual observed completion rate varied widely across studies. Sign out was the most poorly performed phase of the checklist (90%) of compliance across studies, but "verification of team-members'' was significantly less compliant. Studies assessing surgical team perceptions found that SSC improved participants' perception of teamwork, communication, patient safety, and staff awareness of adverse events. However, when stakeholders placed differing degrees of importance on SSC completion, results indicated the SSC might actually antagonize team relationships. SSC compliance varies significantly across studies, being highly dependent on staff perceptions, training, and effective leadership. Surgical teams have positive perceptions of SSC; thus with effective implementation strategies, compliance rates across all phases can be substantially improved

Attitudes and compliance to the WHO Surgical Safety Checklist: a review

Background: This review aimed to assess surgical safety checklist compliance (SSC) and evaluate surgical team attitudes post checklist implementation. Method: A thorough search of MEDLINE and PUBMED databases for English language studies using any adapted form of the WHO SSC was conducted. In total 26 studies; 13 assessing SSC compliance and 13 investigating surgical team attitudes to the checklist, were evaluated. Results: Compliance studies deomnstrated a checklist initiation rate of >90% but showed completion rates to be significantly lower across studies. "sign out" was the most poorly performed phase (<50%) with "Time out" being the best. Verification of team-members' varied greatly. Surgical team attitudes noted improved teamwork, communication, patient safety and staff awareness of adverse events

Staff attitudes and compliance toward the Surgical Safety Checklist in North Queensland

The Surgical Safety Checklist (SSC) has been reported to decrease complications and mortality; however, it is unclear which aspects are most crucial in producing its associated benefits and whether the positive attitudes of the operating room (OR) staff toward the SSC translates into better checklist compliance. This study aims to compare staff attitudes about reported benefits of and potential barriers to the SSC against observed compliance in 3 multispecialty North Queensland hospitals. SSC compliance, attitudes, and socio-professional factors were assessed via a staff survey consisting of a modified OR version of the Surgical Attitudes Questionnaire. A direct observation study of 165 procedures was concurrently performed to assess compliance with and accuracy of SSC completion at The Townsville Hospital. A total of 205 responses were received (response rate, 70%). Of these, 29.6% of responses were from private hospital staff. Survey responses versus observations indicated a 20% margin between satisfactory initiation and verbal completion of the SSC, with Sign Out both unsatisfactorily initiated (26%) and verbally completed (18%) (P < 0.05). "Staff introduction" was poorly completed and reported as not important (P = 0.005). Disinterest from other staff as perceived by nurses was seen as the greatest barrier to SSC completion. Surgeons and anesthesiologists valued the importance and benefits of the checklist less than half as much as nurses (P < 0.05). The SSC in its present form is not fully embraced in North Queensland hospitals. Making amendments to the checklist and its implementation protocols that reflect local cultural and social settings is desirable to improve compliance