Yaseen Sana J, Taha Sari, Alkaiyat Abdulsalam, Zyoud Sa'ed H
Faculty of Graduate Studies, Public Health Management Program, An-Najah National University, Nablus, 44839, Palestine.
Quality and Patient Safety Department, An-Najah National University Hospital, Nablus, 44839, Palestine.
BMC Health Serv Res. 2025 Jan 20;25(1):103. doi: 10.1186/s12913-025-12288-6.
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.
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.
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.
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.
不安全的手术操作是可预防的发病和死亡原因。世界卫生组织发布了手术安全核对表（SSC），以帮助减少手术失误和并发症并改善患者预后。本研究旨在审核对世界卫生组织SSC的依从性，并探讨低收入和中等收入国家医院对其实施的态度。
这是一项分为两部分的横断面研究，其中使用回顾性案头审查来审核SSC的使用依从性，并使用问卷来探讨对SSC的态度。2021年9月至11月期间从两家主要的政府和非政府医院收集数据。邀请外科医生、麻醉师和手术护士完成一份自我管理的问卷，该问卷通过5点李克特量表测量五个领域的态度。
最终样本包括340例患者，其记录从一家政府医院（n = 170）和一家非政府医院（n = 170）中检索。在这些患者中，93例（27.4%）接受了普通外科手术，49例（14.4%）接受了骨科手术，45例（13.2%）接受了小儿外科手术。27.9%的患者的SSC已完全填写，43.2%的患者部分填写，28.8%的患者留空。SSC的使用依从性与年龄（p = 0.002）、性别（p = 0.022）、手术类型（p < 0.001）、手术分级（p = 0.006）和医院部门（p < 0.001）显著相关。政府医院的患者中没有一人完全填写了SSC，而非政府医院的患者中没有一人的SSC留空。在研究其态度的80名手术室工作人员的最终样本中，分别有41.3%、40.0%和18.8%是外科医生、手术护士和麻醉师。参与者在所有态度领域对SSC都表现出积极态度。大多数人表示，时间不足（56.3%）、工作人员的坚定性（55.0%）和培训（53.8%）是实施SSC的最重要障碍。医院部门在所有领域的得分均显著更高。
虽然大多数手术室工作人员使用了SSC，但只有少数人完全填写了清单。对使用世界卫生组织SSC的态度呈积极趋势，这鼓励在国家层面正式实施SSC。解决已确定的障碍可能通过提供教育课程来提高实施质量。建议未来进行重新审核以提高SSC的适应性。
