Department of Surgery, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
Department of Surgery, Stanford University, Palo Alto, California, USA.
Br J Surg. 2023 Oct 10;110(11):1511-1517. doi: 10.1093/bjs/znad234.
The WHO Surgical Safety Checklist reduces morbidity and mortality after surgery, but uptake remains challenging. In particular, low-income countries have been found to have lower rates of checklist use compared with high-income countries. The aim of this study was to determine the impact of educational workshops on Surgical Safety Checklist use implemented as part of a quality improvement initiative in five hospitals in Ethiopia that had variable experience with the Surgical Safety Checklist.
From April 2019 to September 2020, each hospital implemented a 6-month surgical quality improvement programme, which included a Surgical Safety Checklist workshop. Statistical process control methodology was used to understand the variation in Surgical Safety Checklist compliance before and after workshops and a time-series analysis was performed using population-averaged generalized estimating equation Poisson regression. Checklist compliance was defined as correctly completing a sign in, timeout, and sign out. Incidence rate ratios of correct checklist use pre- and post-intervention were calculated and the change in mean weekly compliance was predicted.
Checklist compliance data were obtained from 2767 operations (1940 (70 per cent) pre-intervention and 827 (30 per cent) post-intervention). Mean weekly checklist compliance improved from 27.3 to 41.2 per cent (mean difference 13.9 per cent, P = 0.001; incidence rate ratio 1.51, P = 0.001). Hospitals with higher checklist compliance at baseline had the greatest overall improvements in compliance, more than 50 per cent over pre-intervention, while low-performing hospitals showed no improvement.
Surgical Safety Checklist workshops improved checklist compliance in hospitals with some experience with its use. Workshops had little effect in hospitals unfamiliar with the Surgical Safety Checklist, emphasizing the importance of multifactorial interventions and culture-change approaches. In receptive facilities, short workshops can accelerate behaviour change.
世界卫生组织手术安全检查表可降低手术后的发病率和死亡率，但推广仍具有挑战性。特别是，与高收入国家相比，低收入国家使用检查表的比例较低。本研究旨在确定在埃塞俄比亚的五家医院实施的质量改进计划中，作为手术安全检查表使用的一部分，对教育研讨会的影响。这些医院对手术安全检查表的使用经验各不相同。
从 2019 年 4 月至 2020 年 9 月，每家医院都实施了为期 6 个月的手术质量改进计划，其中包括手术安全检查表研讨会。使用统计过程控制方法来了解研讨会前后手术安全检查表的遵守情况的变化，并使用基于人群的广义估计方程泊松回归进行时间序列分析。检查表的遵守情况定义为正确完成签到、暂停和签出。计算干预前后正确使用检查表的发生率比，并预测平均每周遵守率的变化。
从 2767 例手术中获得了检查表遵守数据（1940 例（70%）为干预前，827 例（30%）为干预后）。每周检查表的平均遵守率从 27.3%提高到 41.2%（平均差异 13.9%，P=0.001；发病率比 1.51，P=0.001）。基线检查表遵守率较高的医院总体遵守率提高幅度最大，超过干预前的 50%，而表现不佳的医院则没有提高。
手术安全检查表研讨会提高了有一定使用经验的医院的检查表遵守率。对于不熟悉手术安全检查表的医院，研讨会效果甚微，这强调了多因素干预和文化变革方法的重要性。在易于接受的医院，简短的研讨会可以加速行为改变。
