Abstract
The World Health Organization (WHO) implemented the Surgical Safety Checklist (SSCL) as a part of Safe Surgery Saves Lives campaign. Even after 12 years of implementation of WHO SSCL, available literature is still lacking from developing countries, where the potentially greatest impact could have been observed. A prospective randomized controlled trial done in Tertiary level hospital from September 2018 – February 2020 enrolled pediatric patients aged 0 day to 15 years. The patients were randomly allocated into groups by lottery as Group A - control and Group B – Intervention group. Group A was given the basic pre-operative care. Group B were enrolled in the safety checklist. The data were collected in the printed forms and analyzed. The patients were followed for surgical site infections (SSI). Compliance of the safety checklist was assessed with completion of the checklist fully or partially. Total cases enrolled were 310 with 155 in each group. Age of patients ranged from 1 day to 15 years. SSI was present in 35 patients in group A and 29 patients in group B. The Outcome of implementation of SSC on appearance of SSI was not significant. SSI was decreased on checklist implementation with OR of 0.78 (95% CI 0.45 – 1.37). Outcome of SSC compliance shown by OR was 0.39 (95% CI 0.15 – 0.99). Use of SSCL decreases the postoperative complications and improves the outcome. Compliance is the key to success of the implementation of the checklist.
Highlights
The evidence and theoretical frameworks for improving surgical outcomes by World Health Organization (WHO) Surgical Safety Checklist (SSC) for successful implementation in low-income countries remain lacking.[1]
Surgical site infection was present in 35 patients in group
Outcome of SSC compliance shown by odds ratio was 0.39
Summary
The evidence and theoretical frameworks for improving surgical outcomes by WHO Surgical Safety Checklist (SSC) for successful implementation in low-income countries remain lacking.[1]. Studies which examine the causes of wrong-site surgeries suggest, the lack of communication among the surgical team members, as the main cause for these error.[2] The Safe Surgery Saves Lives Project was initiated by World Alliance for Patient Safety in June 2008, which increased the legal liability to raise awareness about patient care safety and reduce the number of deaths caused by surgeries worldwide.[3]. Compliance remains a major problem in implementation of checklist, despite its effectiveness in increasing patient safety and causes gaps in its daily use till date.[4] Research has suggested that barriers to implementation of the SSC include staff hierarchy, time constraints, inconsistent delivery with omission of items.[5] Viewing the checklist as a tick box exercise and nobody assuming responsibility for sign-out checks lead to its omission.[5] Making the SSC mandatory does not lead to the expected outcome of reducing risks for patients and non-adhering to internal guidelines is seen to be a commonly accepted practice.[6] The benefits of the checklist have been elaborated in various research articles. Various studies have been done on why there is no compliance in spite of those benefits
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