Compliance and Surgical Team Perceptions of WHO Surgical Safety Checklist; Systematic Review

Abstract

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 (,50%) with time out being the best. Verification of patient identity and procedure demonstrated a high degree (.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

Good practices for patient safety in the operating room: nurses' recommendations

“…This Program aims at reducing the number of deaths and surgical complications such as performing surgery on the patient or wrong location and inadvertent retention of foreign bodies. Thus, the checklist aims to reinforce patient safety practices and promote better communication among health professionals (22)(23) .…”

How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties in Norway

“…The "Sign-In" review was seen as redundant, coinciding with former arguments of SSC performance being double checking routines. ( (17,46) In addition to the narrower and wider risk perceptions, we found that SSC utilisation is also a function of how it is incorporated into team membersʼ workflow schedules in OT, and how much effort has been spent reducing practical barriers within the team. (47) This finding corroborates previous investigations.…”

Anspruch und Wirklichkeit: Umsetzung der G-BA Qualitätsmanagement-Richtlinie bezüglich der Anwendungspraxis der OP-Checkliste – Status Quo an einem universitären Maximalversorger

“…Der Vergleich mit der internationalen Literatur bezogen auf Compliance-Raten hinsichtlich der Präsenz der »Surgical-Safety-Checklist« im chirurgischen Setting erbringt eine äußerst inhomogene Datenlage. So beträgt in den Übersichtsarbeiten von 2014 aus neun spanischen Krankenhäusern und aus 2016 mit 13 Studien die Spannbreite der Compliance-Raten zur Anlage der SSC zwischen 63,7 und 100,0 % [18,26] Vilz et al (2016) dokumentierten für eine vergleichbare nationale Einrichtung der universitären Maximalversorgung folgende Werte für die Anwendung der Phasen: »Sign-In« 48,0 % in 2010 und 83,0 % in 2012, bzw. »Team-Time-Out« 35,0 % und 63,0 % für die analogen Zeiträume [28].…”

“…Mit dem positiv veränderten Heilverlauf korreliert eine Erhöhung der Sicherheitskultur im OP-Saal, die arbeitspsychologisch durch eine veränderte Wahrnehmung des Stellenwerts von Teamarbeit begründet wird und als Nebeneffekt der Checkliste gilt [14,17]. Die WHO schätzt, dass durch die konsequente Umsetzung der SSC mindestens 500 000 Todesfälle pro Jahr weltweit vermieden werden könnten [18,19].…”