Jhpiego Tanzania, Plot 72, Block 45B, Victoria, New Bagamoyo Road, Dar-es-Salaam, Tanzania.
Jhpiego, Baltimore, USA.
World J Surg. 2020 Mar;44(3):689-695. doi: 10.1007/s00268-019-05292-5.
Millions of patients worldwide suffer disability and death due to complications related to surgery. Many of these complications can be reduced by the use of the World Health Organization (WHO) Surgical Safety Checklist (SSC), a simple tool that can enhance teamwork and communication and improve patient safety. Despite the evidence on benefits of its use, introducing and sustaining the use of the checklist are challenging. We present a team-based approach employed in a low-resource setting in Tanzania, which resulted in high checklist utilization and compliance rates.
We reviewed reported data from facility registers supplemented by direct observation data by mentors to evaluate the use of the WHO SSC across 40 health facilities in two regions of Tanzania between January and December 2018. We analyzed the self-reported monthly data on total number of major surgeries performed and proportion of surgeries where the checklist was used. We also analyzed the use of the SSC during direct observation by external mentors and completion rates of the SSC in a random selection of patient files during two mentorship visits between June and December 2018.
During the review period, the average self-reported checklist utilization rate was 79.3% (11,564 out of 14,580 major surgeries). SSC utilization increased from 0% at baseline in January 2018 to 98% in December 2018. The proportion of checklists that were completely and correctly filled out increased between the two mentor visits from 82.1 to 92.8%, but the gain was significantly greater at health centers than at hospitals (p < 0.05). Health centers (which had one or two surgical teams) self-reported a higher checklist utilization rate than hospitals (which had multiple surgical teams), i.e., 99.4% vs 68.8% (p < 0.05).
Our findings suggest that Surgical Safety Checklist implementation is feasible even in lower-resource settings. The self-reported SSC utilization rate is higher than reported in other similar settings. We attribute this finding to the team-based approach employed and the ongoing regular mentorship. We recommend use of this approach to scale-up checklist use in other regions in the country as recommended in the Ministry of Health of Tanzania's National Surgical, Obstetric, and Anesthesia Plan (NSOAP).
全球数以百万计的患者因手术相关并发症而致残和死亡。许多这些并发症可以通过使用世界卫生组织（WHO）手术安全检查表（SSC）来减少，这是一种简单的工具，可以增强团队合作和沟通，并提高患者安全性。尽管有证据表明其使用有益，但引入和维持检查表的使用具有挑战性。我们介绍了在坦桑尼亚一个资源有限的环境中采用的基于团队的方法，该方法导致检查表的高利用率和高合规率。
我们回顾了 2018 年 1 月至 12 月期间在坦桑尼亚两个地区的 40 家卫生机构报告的数据，并辅以导师的直接观察数据，评估了 WHO SSC 在这些机构中的使用情况。我们分析了自我报告的每月总例数和使用检查表的手术比例。我们还分析了外部导师在直接观察期间使用 SSC 的情况，以及在 2018 年 6 月至 12 月期间两次导师访问期间随机选择的患者档案中 SSC 的完成情况。
在审查期间，自我报告的检查表利用率平均为 79.3%（14580 例主要手术中的 11564 例）。SSC 的利用率从 2018 年 1 月的 0%逐月增加，到 12 月达到 98%。两次导师访问之间，完全正确填写的检查表比例从 82.1%增加到 92.8%，但卫生中心的增长幅度明显大于医院（p<0.05）。只有一个或两个手术团队的卫生中心自我报告的检查表利用率高于拥有多个手术团队的医院，即 99.4%比 68.8%（p<0.05）。
我们的发现表明，即使在资源较少的环境中，手术安全检查表的实施也是可行的。自我报告的 SSC 利用率高于其他类似环境中的报告。我们将这一发现归因于所采用的基于团队的方法和持续的定期指导。我们建议在坦桑尼亚卫生部的国家外科、产科和麻醉计划（NSOAP）中推荐的其他地区使用这种方法来扩大检查表的使用。
