Multicenter audit of operating room staff compliance with the surgical safety checklist: a cross-sectional study from a low- and middle-income country.

BACKGROUND

Unsafe surgical practices are a preventable cause of morbidity and mortality. The WHO published its surgical safety checklist (SSC) to help reduce surgical errors and complications and improve patient outcomes. This study aims to audit compliance with the WHO's SSC and explore attitudes toward its implementation in hospitals within a low- and middle-income country.

METHODS

This was a two-part, cross-sectional study in which a retrospective desk review was used to audit compliance with SSC use, and a questionnaire was used to explore attitudes toward the SSC. The data were collected between September and November 2021 from two major governmental and nongovernmental hospitals. Surgeons, anesthesiologists, and surgical nurses were invited to complete a self-administered questionnaire that measured attitudes across five domains via a 5-point Likert scale.

RESULTS

The final sample consisted of 340 patients whose records were retrieved from one governmental hospital (n=170) and one nongovernmental hospital (n=170). Among those patients, 93 (27.4%) underwent general surgery, 49 (14.4%) underwent orthopedic surgery, and 45 (13.2%) underwent pediatric surgery. The SSCs were fully completed for 27.9% of the patients, partially completed for 43.2% of the patients, and left blank for 28.8% of the patients. Compliance with the use of the SSC was significantly associated with age (p=0.002), sex (p=0.022), type of surgery (p<0.001), classification of surgery (p=0.006) and hospital sector (p<0.001). None of the patients at the governmental hospital had a completely filled the SSC, whereas none of those at the nongovernmental hospital had a blank SSC. Among the final sample of 80 operating room staff members included in the study that explored their attitudes, 41.3%, 40.0%, and 18.8% were surgeons, surgical nurses, and anesthesiologists, respectively. The participants demonstrated positive attitudes toward the SSC across all the attitude domains. The majority said that lack of time (56.3%), staff assertiveness (55.0%), and training (53.8%) were the most important barriers to implementing the SSC. The hospital sector was significantly associated with higher scores across all domains.

CONCLUSIONS

While the majority of operating room staff used the SSC, only a minority filled the list completely. The attitudes toward using the WHO's SSC trended positively, which encourages the official implementation of the SSC at the national level. Addressing the identified barriers may enhance the quality of implementation by providing educational sessions. Future reaudits are recommended to enhance the adaptability of the SSC.