BackgroundAppropriate utilization and compliance of Surgical Safety Checklist reduces occurrence of perioperative surgical complications and improve patient outcomes. However, data on compliance of surgical checklists are scarce in the study area. Therefore, the aim of this study was to evaluate compliance of checklist completion and its barrier for utilization at University of Gondar Hospital, Northwest Ethiopia.MethodsA prospective observational study was conducted among 282 patients undergoing elective and emergency surgery from January to March 2013. Compliance and completeness rate with implementation of Sign-in, Time-out, and Sign-out domains was computed with SPSS 20 package.ResultsA total of 282 operations were performed and checklists were utilized in 39.7 % (112/282) of cases. Among these, most checklists were employed during emergency procedures (61.6 %) that need general anesthesia (75.9 %) in department of surgery (58.9 %). The overall compliance and completeness rate were 39.7 and 63.4 % respectively. The sign-in, time-out and sign-out were missed in 30.5 % (273/896), 35.4 % (436/1,232) and 45.7 % (307/672) respectively. The main reasons cited for non-user were lack of previous training (45.1 %) and lack of cooperation among surgical team members (21.6 %).Conclusions and recommendationsThe completeness rate was satisfactory but the overall compliance rate was suboptimal. An instrument that is used 40 % of the time has been a fairly basic introduction without significant reinforcement training. Moreover, frequent use of the checklist during emergency cases has been deemed to be of value by clinicians. Supplementary training and attention to actual checklist use would be indicated to ensure that this valuable tool could be used more routinely and improve communication. Conducting regular audit of checklist utilization is also recommended.

Introduction: Postoperative complications, although other complications may occur, involving the respiratory tract is the most frequent one that contribute to the greatest peri operative morbidity and mortality. The occurrence of postoperative pulmonary complications varies depending on the clinical treatment setting, the kind of surgery and the definition used.

Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. A modification of this technique is implemented in certain clinical circumstances. Search engines like Pub Med through HINARI, Cochrane database, Google Scholar to get access for current and updated evidences on modified RSII. This guideline provides a strategy to manage and reduce complications of anesthesia in patients who are easily suspectable for desaturation. Senior anaesthetists’, with input from department of surgery, were responsible to develop this clinical guideline to promote the best evidence-based, effective, affordable, and safer management of the indicated patients with modified RSII. As part of the guideline development process, a systematic review of studies published in peer-review journals were employed on varies aspects related to treatment, assessment and risk stratification. After a comprehensive searching of electronic sources and a review of the evidence, the authors formulated recommendations that addressed various aspects of optimization of patients, considering setups with limited recourse. Highlights:

Background: Surgical safety checklists (SSCs) are designed to improve interprofessional communications and ultimately avoiding catastrophic errors that often characterizes the culture of surgical teams. However, data on the effect of surgical checklists implementation are scarce in the study area. The purpose of this research project was to directly examine the effect of utilization surgical safety checklist on patient outcomes at the University of Gondar Hospital, in Northwest Ethiopia. Material and methods: Institution based cross-sectional study was conducted at University of Gondar Hospital from January to May 2013. We reviewed medical records of all consecutive patients admitted to the surgery department (N=403). For those who have clinical symptoms of surgical site infection, a laboratory diagnosis was performed to compare occurrences of all postoperative complication among patients with and without utilization of surgical safety checklist. Results: During the study period from 403 patients operated, SSCs were attached for only 158 (39.2%) of the surgical patients. The postoperative complication was observed in 238 (59 %) of the patients, and postoperative fever was the primary complication accounting for 70 (17.3%) of all the complication. Surgical wound infection and pneumonia accounted for 47(16.6%) and 33(11.7%) respectively. S. aureus was the predominantly isolated bacteria accounted for 7(30%). Also, a statistically non-significant 11.2% decline the rate of surgical wound infection in the checklist group. In a logistic regression model of postoperative fever, the SSCs emerged as a significant independent predictor of this outcome: (OR = 0.49, 95% CI 0.31-0.75, and P-value = 0.001). Conclusions and recommendations: Patients with checklist have observed significant reductions of postoperative complication particularly bacterial infection. It is possible to some extent that the improved usage of the checklist and preoperative prophylactic antibiotics may be implicated in the reduction of postoperative fever and bacterial infection.