University Teaching Hospital, Nationalist Rd, Lusaka, Zambia.
Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMC Health Serv Res. 2022 Jul 9;22(1):894. doi: 10.1186/s12913-022-08257-y.
Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia.
A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis.
Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior surgeon ownership of the initiative, when the SSC was introduced at UTH 5 years earlier. Low utilisation was also linked to factors such as: negative attitudes towards it, the hierarchical structure of surgical teams, lack of support for the SSC among senior surgeons and poor teamwork. Further determinants included: lack of training opportunities, lack of leadership and erratic availability of resources. Interviewees proposed the following strategies for improving SSC utilisation: periodic training, refresher courses, monitoring of use, local adaptation, mobilising the support of senior surgeons and improvement in functionality of the surgical teams.
The SSC has the potential to benefit patients; however, its utilisation at the UTH has been patchy, at best. Its full benefits will only be achieved if senior surgeons are committed and managers allocate resources to its implementation. The study points more broadly to the factors that influence or obstruct the introduction and effective implementation of new quality of care initiatives.
手术围手术期死亡和主要并发症是造成全球和撒哈拉以南非洲地区可预防发病率的重要原因。世界卫生组织（WHO）开发了手术安全检查表（SSC），通过利用团队方法和一系列步骤来确保患者安全通过手术操作，从而降低手术死亡率和并发症。本研究探讨了在赞比亚卢萨卡的教学医院（UTH）使用检查表的障碍和促进因素。
进行了一项定性案例研究，涉及 UTH 外科部门的手术团队成员（医生、麻醉师、护士和支持人员）。采用目的抽样法，于 2018 年 12 月至 2019 年 3 月期间进行了 16 次深入访谈。使用主题分析对数据进行转录、组织和分析。
分析显示，外科团队对 SSC 的实施存在差异，这源于 5 年前在 UTH 引入 SSC 时缺乏高级外科医生对该倡议的所有权。低利用率还与以下因素有关：对其持消极态度、外科团队的等级结构、高级外科医生对 SSC 的支持不足以及团队合作不佳。进一步的决定因素包括：缺乏培训机会、缺乏领导力和资源的不稳定可用性。受访者提出了以下改善 SSC 利用率的策略：定期培训、进修课程、监测使用情况、进行本土化调整、争取高级外科医生的支持以及改进手术团队的功能。
SSC 有可能使患者受益；然而，在 UTH 的利用率充其量只是零星的。只有当高级外科医生承诺并管理人员分配资源来实施 SSC 时，才能充分发挥其效益。该研究更广泛地指出了影响或阻碍新的护理质量举措的引入和有效实施的因素。
