Krstulović Jure, Hrgović Zrinka, Krešo Ante, Tavra Ante, Znaor Ljubo, Marušić Ana
School of Medicine, University of Split, Šoltanska 2A, 21000 Split, Croatia.
Department of Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia.
Healthcare (Basel). 2025 Aug 10;13(16):1959. doi: 10.3390/healthcare13161959.
The World Health Organization's Surgical Safety Checklist (WHO SSC) is known to reduce surgical complications and mortality, yet its implementation remains inconsistent across institutions. This study evaluated compliance with a modified SSC and assessed the impact of structured interventions to improve adherence at the University Hospital of Split, Croatia. A before-and-after study analyzed a sample of 1437 completed SSCs over four time points between April 2024 and May 2025: the baseline and after three successive interventions (an official letter from the hospital director emphasizing mandatory SSC use, individual meetings with department heads and head nurses reinforcing its importance, and a quality audit review of SSC completeness with leadership). Checklist completeness was assessed across five SSC sections: General Information, Sign In, Time Out, Sign Out, and Staff Info. Overall checklist completeness increased from 78.3 ± 8.5% at baseline to 86.3 ± 2.5%, 92.0 ± 3.8%, and 94.7 ± 4.8% after the first, second, and third interventions, respectively ( < 0.001). All checklist sections improved significantly: General Info rose from 91.1 ± 6.0% to 98.6 ± 2.6% ( < 0.001); Sign In from 85.0 ± 11.4% to 97.0 ± 3.5% ( = 0.002); Time Out from 79.0 ± 14.6% to 96.4 ± 6.5% ( < 0.001); Sign Out from 70.2 ± 11.2% to 87.7 ± 11.0% ( = 0.003); and Staff Info from 70.7 ± 12.9% to 100.0 ± 0.0% ( < 0.001). Post hoc testing confirmed significant gains versus baseline for all three interventions (Dunnett's test), with a further significant improvement between the first and third interventions (Tukey's HSD, = 0.011). Structured, low-cost interventions emphasizing administrative support, education, and communication significantly improved SSC adherence across a large tertiary hospital. This initiative represents a pioneering effort in Croatia and offers a scalable model for similar public healthcare systems aiming to enhance patient safety.
众所周知，世界卫生组织手术安全核对表（WHO SSC）可降低手术并发症和死亡率，但其在各机构的实施情况仍不一致。本研究评估了对改良版SSC的依从性，并评估了结构化干预措施对提高克罗地亚斯普利特大学医院依从性的影响。一项前后对照研究分析了2024年4月至2025年5月期间四个时间点的1437份已完成的SSC样本：基线期以及三次连续干预之后（医院院长的一封公函强调必须使用SSC，与科室主任和护士长单独会面强化其重要性，以及由领导层对SSC完整性进行质量审核）。在SSC的五个部分评估核对表的完整性：一般信息、签到、暂停、签出和人员信息。总体核对表完整性从基线期的78.3±8.5%分别提高到第一次、第二次和第三次干预后的86.3±2.5%、92.0±3.8%和94.7±4.8%（<0.001）。所有核对表部分均有显著改善：一般信息从91.1±6.0%提高到98.6±2.6%（<0.001）；签到从85.0±11.4%提高到97.0±3.5%（=0.002）；暂停从79.0±14.6%提高到96.4±6.5%（<0.001）；签出从70.2±11.2%提高到87.7±11.0%（=0.003）；人员信息从70.7±12.9%提高到100.0±0.0%（<0.001）。事后检验证实所有三次干预与基线期相比均有显著提高（Dunnett检验），第一次干预和第三次干预之间有进一步显著改善（Tukey's HSD，=0.011）。强调行政支持、教育和沟通的结构化低成本干预措施显著提高了大型三级医院对SSC 的依从性。该举措是克罗地亚的一项开创性努力，为旨在提高患者安全的类似公共医疗系统提供了一个可扩展的模式。
