Abstract
Objective:The aim of this study is to modify the World Health Organization (WHO) Surgical Safety Checklist in order to be compatible to a hospital in Iran and measure effect of implementing this checklist on postoperative complications.Methods:In a cross-sectional study the views of surgeons and anesthesiologists of the main teaching hospital in Tabriz -Imam Reza Hospital- were taken by a form attached to the main checklist. The participants in this study asked to write their opinions on each item of checklist based on the environment of the hospital. Then, we performed before-after study to determine effect of a modified checklist implementing on postoperative complications.Results:Surgeons and anesthesiologists had consensus on 15 of 19 items of checklist to remain the same and just 4 items recommended to be changed. In pre intervention period of study, 100 patients (51 males and 49 females) were enrolled with the mean age of 48.5±13.5 years. The number of patients in the post intervention period was the same, but 49 males and 51 females, the mean age was 47.5 ±14.6 years. The incidence of any complications in pre intervention period was 30%, but this rate in post intervention period was 12% and the difference between 2 periods of study was statistically significant (p=0.002).Conclusion:World Health Organization Surgical Safety Checklist is better to modify based on the local needs and facilities in each hospital. After implementing of a modified surgical safety checklist, complications decreased by 58%.
Highlights
Complications of surgical care have become a major cause of death and disability worldwide, Data from 56 countries showed that in 2004 the annual volume of major surgery was an estimated nearly one operation annually for every 25 human beings alive[1,2]
The main directors of operating rooms in Imam Reza hospital are eight anesthesiologists and eleven surgeons who are academic members of Tabriz university of medical science with an average of 12 years experience in their jobs. they all participated in study
The opinions of the general surgeons and anesthesiologists on 19 items of the World Health Organization (WHO) surgical safety checklist were analyzed by the researcher .Seven anesthesiologists and two surgeons recommended to change the forth item of "before induction of anesthesia" part, overall as follow: "changing pulse oximeter to vital sign and base monitoring"
Summary
Complications of surgical care have become a major cause of death and disability worldwide, Data from 56 countries showed that in 2004 the annual volume of major surgery was an estimated nearly one operation annually for every 25 human beings alive[1,2]. Ten essential objectives included: Objective 1: The team will operate on the correct patient at the correct site, Objective 2: The team will use methods known to prevent harm from administration of anaesthetics, while protecting the patient from pain, Objective 3: The team will recognize and effectively prepare for life-threatening loss of airway or respiratory functions, Objective 4: The team will recognize and effectively prepare for risk of high blood loss, Objective 5: The team will avoid inducing an allergic or adverse drug reaction for which the patient is known to be at significant risk, Objective 6: The team will consistently use methods known to minimize the risk for surgical site infection, Objective 7: The team will prevent inadvertent retention of instruments and sponges in surgical wounds, Objective 8: The team will secure and accurately identify all surgical specimens, Objective 9: The team will effectively communicate and exchange critical information for the safe conduct of the operation, Objective 10: Hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results Regarding these 10 objectives, WHO surgical safety checklist covered 3 surgical stages –before anesthesia, immediately before an incision, and before moving the patient to a recovery room respectively SINE IN,TIME OUT and SIGN OUT parts [1]. In 2011, application of surgical safety checklist in Shiraz, Faghihy hospital decreased complications after Implementation of the checklist [9]
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