Safety Checklist Research Articles

Implementation of the Surgical Safety Checklist in Central Surgical Unit of Santo Antonius Hospital Pontianak

Surgical Safety Checklist (SSC) is a patient safety procedure in the form of a checklist created by WHO as the basis for actions carried out by the surgical team. The aim is to find out an overview of the Implementation of the Surgical Safety Checklist. This research is quantitative descriptive observational. Checklist sheet instrument. Sample of 69 surgical patients using accidental sampling technique. The results of more than half of the implementation of SSC, namely 41 operations (59.4%) were in the poor category because the surgical team was less consistent in carrying out SSC in each phase, namely more than half of the implementation of sign-in, 39 operations (56.5%) were insufficient, the implementation of time out was 35 surgery (50.7%) was lacking and the implementation of sign out was 45 operations (65.5%) lacking. Conclusion: The implementation of the Surgical Safety Checklist in the Central Surgical Unit at Santo Antonius Hospital Pontianak is in the poor category.

6.G. Workshop: Quality assessment in perioperative care: Challenges and lessons learned from the SAFEST project

Abstract Approximately 313 million surgical procedures are performed worldwide annually, with millions of patients experiencing health benefits while many suffer perioperative complications and harm. World Bank estimations show over 7 million people suffering surgical complications annually, with 4.2 million deaths occurring within 30 days of surgery, placing perioperative mortality as the third most common cause of death. Beyond the ethical issues of patients suffering personal harm while undergoing care, the burden on the health system due to prolonged length of stay and treatment is critical. Perioperative morbidity and mortality have thus become a high-priority public health problem for health systems. Attempts to set targets for improvement adopted well-known conceptual frameworks to categorise areas of evaluation (e.g., Donabedian model) and acknowledged the multifactorial root of perioperative harm and the various patient-condition and system-level factors have been fundamental in perioperative safety. International collaboration is active in seeking to address the challenges of measurement and reporting (COMPAC-StEP), while various tools have been utilised for that purpose (e.g., WHO surgical safety checklist). Several indicators, agreed among experts based on empirical research, have been adopted to assess quality at pre- intra- and postoperative care, but seen as blunt to accurately describe system performance and indicate areas of improvement. This has resulted in poorly defined measures of uncertain value, lacking validity, reliability, and lawfulness, and raising doubts about their true impact on patient safety. On the other hand, patient-centeredness and meaningfulness for patients remain unclear, while traditional clinical measures are increasingly found inadequate to capture all aspects of patient care and recovery. Overall, evidence is still conflicting regarding the most appropriate markers of quality, while long-term and patient-centred outcomes are gaining more scientific attention, despite the various implementation challenges. Greater involvement of patients in the development and selection process of quality indicators is seen as fundamental to better reflect patient values in quality targets in healthcare. A main goal of the workshop is to discuss the challenges and the latest developments in quality assessment in perioperative care and turn the attention towards “evidence-based indicators” for improving quality of care and safety in the perioperative period. The SAFEST project and its approach to developing recommendations and core indicators for patient safety in perioperative care will be presented. The special contribution of patient representatives in the SAFEST stakeholder consensus will be identified. Attributes of ideal quality indicators will be highlighted with reference to evidence-based, important reliable, and actionable indicators and those most prominent in measuring patient-related outcomes of care. Key messages • Translating perioperative safety clinical guidelines recommendations into measurable standards and assess a core of indicators will enhance the implementation of patient safety best practices.

Fair Healthcare Practices in Orthopedics Assessed with a New Framework.

Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.

Safety and Feasibility of an Emergency Department-to-Outpatient Pathway for Patients With TIA and Nondisabling Stroke.

Evaluation of transient ischemic attack/nondisabling ischemic strokes (TIA/NDS) in the emergency department (ED) contributes to capacity issues and increasing health care expenditures, especially high-cost duplicative imaging. As an institutional quality improvement project, we developed a novel pathway to evaluate patients with TIA/NDS in the ED using a core set of laboratory tests and CT-based neuroimaging. Patients identified as 'low risk' through a safety checklist were discharged and scheduled for prompt outpatient tests and stroke clinic follow-up. In this prespecified analysis designed to assess feasibility and safety, we abstracted data from patients consecutively enrolled in the first 6 months. We compared data from 106 patients with TIA/NDS enrolled in the new pathway from April through September 2020 (age 67.9 years, 45% female), against 55 unmatched historical controls with TIA encountered from April 2016 through March 2017 (age 68.3 years, 47% female). Both groups had similar median NIHSS scores (pathway and control 0) and ABCD2 scores (pathway and control 3). Pathway-enrolled patients had a 44% decrease in mean ED length of stay (pathway 13.7 hours, control 24.4 hours, p < 0.001) and decreased utilization of ED MRI-based imaging (pathway 63%, control 91%, p < 0.001) and duplicative ED CT plus MRI-based brain and/or vascular imaging (pathway 35%, control 53%, p = 0.04). Among pathway-enrolled patients, 89% were evaluated in our stroke clinic within a median of 5 business days; only 5.5% were lost to follow-up. Both groups had similar 90-day rates of ED revisits (pathway 21%, control 18%, p = 0.84) and recurrent TIA/ischemic stroke (pathway 1%, control 2%, p = 1.0). Recurrent ischemic events among pathway-enrolled patients were attributed to errors in following the safety checklist before discharge. Our TIA/NDS pathway, implemented during the initial outbreak of COVID-19, seems feasible and safe, with significant positive impact on ED throughput and ED-based high-cost duplicative imaging. The safety checklist and option of virtual telehealth follow-up are novel features. Broader adoption of such pathways has important implications for value-based health care.

Lessons From Social Psychology to Improve the Implementation and Use of the Surgical Safety Checklist in the Operating Room.

Lessons From Social Psychology to Improve the Implementation and Use of the Surgical Safety Checklist in the Operating Room.

A CROSS-SECTIONAL STUDY OF SURGICAL SMOKE INHALATION, ITS HAZARDS AND PREVENTION AMONG PAEDIATRIC SURGICAL RESIDENTS IN PAKISTAN

Background: For thousands of years human beings have been using heat as a source of ligature and to treat the wound either it’s from the trauma or fought in the wars. In 1854 an imminent surgeon Albrecht Theodor Middendorf published a paper on the application of electrocautery in surgical operations. The objective of the study was to analyze the hazards of surgical smoke inhalation in Paediatric Surgery residents and to create awareness of its signs and symptoms, risk factors and utilizing preventive measures. Methods: A Cross-sectional study was conducted involving all the Paediatric Surgery residents enrolled on a supervised training program in Pakistan between 1st July 2022 to 30th June 2023 at all the tertiary care hospitals in Pakistan. Their socio-demographic, academic data, signs and symptoms and risk factors were calculated. Data was analyzed with descriptive and comparative analysis using SPSS. A Pearson contingency coefficient is used to determine the association between categorical variables. Results: Our study included all the Paediatric Surgery residents in Pakistan n=155 over a span of one year starting from July 1st 2022 to June 30th 2023. N=75 (48.4%) were males and n=80 (52.6%) were female residents. Their mean age was 29.5 years±4 (SD). 41% of the residents were from Khyber Teaching Hospital, 32% from Children’s Hospital, 14% from National Institute of Child Health Karachi, 9.8% from Children’s Hospital Islamabad (PIMS) and 5.2% from Lady Reading Hospital Peshawar. N=135 (87.1%) of the residents used electrocautery while performing the surgery (p=0.006). N=121 (78.1%) were aware of its hazards (p=0.341). 90% think they are at an increased risk (p=0.032). Most of them (84.6%) wear a surgical mask while only (64%) wear protective equipment (p=0.321). Think they are at an increased risk of cancers (83.9%) (p=0.002) and should be screened (93.7%) (p=0.343). Conclusion: Paediatric surgery residents are at an increased risk of surgical smoke inhalation, pointing to the emerging need to adopt protective measures by creating awareness, and utilizing health safety checklists and smoke evacuation mechanisms in operation rooms. All residents should seek knowledge on the subject and use personal protective equipment for less harmful effects on their health.

Implementing surgical safety checklists in veterinary medicine: where do we currently stand?

Implementing surgical safety checklists in veterinary medicine: where do we currently stand?

Surgical safety: effectiveness based on collective intelligence and implementation challenges (review)

The authors used databases Scopus, PubMed, Web of Science, MedLine, RSCI for a systematic periodicals review on surgical safety issues published from 2000 to 2022. The literature review has shown that organization of interaction and communication, quality of completion of the checklist, assessment of the clinical effectiveness of the checklist, possibility of adapting the checklist to the conditions of a particular surgical department, increased compliance of healthcare professionals with the use of the surgical safety checklist, possibility of patient participation in completing the checklist appear to be the basic issues requiring a critical look and a prospective discussion. The introduction of individual components of quality control and medical care safety is known to be a rather long and staged process, during which systematic approaches, starting points and control points are repeatedly reviewed. The high level of specialists training and concentration, the need for clear communications within the surgical team, strict follow the preventive rules can serve as the initial guidelines requiring constant training control. The process principle of quality service management and the incorporation of new technologies for optimization filling and digitalization of the checklist will improve the efficiency and effectiveness of surgical safety.

FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery.

FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage-related maternal deaths in many low- and middle-income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence-based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta.

Use of Technology to Improve the Adherence to Surgical Safety Checklists in the Operating Room.

Although checklists can improve safety in the operating room (OR), compliance with their use is variable. Use of a forcing function, a principle of human factors engineering, has not been reported earlier as a method of increasing checklist use. The authors conducted this study to determine the feasibility and effects of introducing a forcing function on OR surgical safety checklist implementation and adherence. The authors developed and introduced the use of an electronic version of the surgical safety checklist on an Android application, provided on a personal device available in the OR. This application was linked by Bluetooth to electrocautery equipment, which could not be started before the electronic checklist was completed on the screen of the personal device. In the same OR, retrospective data from use of the traditional (paper-based) checklist were compared with data from the new electronic checklist for frequency of use, and completeness (percentage of all checklist items completed) at three stages of the surgical process-sign-in, time-out, and sign-out. The frequency of use was 100.0% for the electronic checklist, compared with 97.9% for the traditional checklist. The frequency of completeness was 27.1% for the traditional vs. 100.0% for the electronic (p < 0.001).The manual checklist's sign-out component was completed only 37.0% of the time. Although checklist use in some form was already high with the traditional checklist, completion rate was low and significantly increased with the use of the electronic checklist with a forcing function.

A Checklist for Radiation Therapy Planning: Update 2023

We developed a checklist to help navigate the radiation simulation and setup process. We distilled the tasks to be performed into an easily memorizable acronym P-P-I-I-I-T (Patient Prescription, Patient Position, Immobilization, Imaging, Image Guided Radiotherapy, and Treatment Technique). This checklist ensures coverage of all the key elements and improves patient safety and treatment planning quality. Since our initial publication, we applied the checklist on 600 patients and are now presenting an update. We updated the checklist to ensure inclusion of the American College of Radiology (ACR) recommendations for radiation planning and incorporated feedback we received from allied radiation oncology professionals. The inspiration behind the easily memorizable acronym, P-P-I-I-I-T, came from a similar published checklist for systematically evaluating of a radiotherapy treatment plan, CB-CHOP, which stands for Contours, Beam Arrangement, Coverage, Heterogeneity/Hot Spots, Organs at Risk and Prescription (Dean et al. 2017), The checklist provides a simplified and standardized approach to treatment plan evaluation. Similarly, P-P-I-I-I-T checklist was put into usage as aid for both learners and staff radiation oncologists, and applied to radiation planning for 600 patients treated in Iowa between 2019 to 2022. During each session another radiation oncologist, two dosimetrists, two radiation nurses, and one physicist were present. The other radiation oncologist acted as observer to ensure the checklist was being applied appropriately by the primary radiation oncologist. The rest of the treatment team provided feedback which was relevant to their professional domains. The feedback from all members was collected and incorporated to make revisions to an updated checklist which was put into use as of January 2023. The components of the revised list are as follows: The following are the components of the revised 2023 checklist: P - Patient Prescription: Confirms the proposed dose, fractionation, and scheduling (such as concurrent chemotherapy). P - Patient Position: Describes optimal position including head, shoulder, arms and legs, alternative positions, and changes due to unexpected issues. I - Immobilization: Considers type of device, 4D set-up, gating, and custom immobilization. I - Imaging: Chooses imaging modality, slice thickness, and contrast agent, as well as fusions for SBRT and SRS. Discusses image guidance incorporating ACR recommendations and reference points. T - Treatment Technique: Includes proposed technique such as 3D, VMAT, electrons, and bolus and energy to be used. Standardization of practical guidelines and safety checklists are increasingly common in medicine. P-P-I-I-I-T (P²I³T) continues to be a simple acronym that can be used by radiation oncology residents and attendings as a checklist to ensure a complete and accurate patient setup and simulation.

CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity

IntroductionThe WHO Surgical Safety Checklist (SSC) is a communication tool that improves teamwork and patient outcomes. SSC effectiveness is dependent on implementation fidelity. Administrative audits fail to capture most aspects...

The WHO Surgical Safety Checklist in Belgian hospitals: Changes in use, knowledge, opinions and perception of pressure among operating room professionals between 2016 and 2021

Background: Implementing a Surgical Safety Checklist (SSC) poses several challenges. Operating room (OR) professionals’ opinions on SSC determine whether it is used. Additionally, OR professionals often complain of pressure for execution and presence of inappropriate components in the SSC. Objectives: This study aimed to investigate whether the use of and opinions on SSC improved, and whether feelings of pressure and opinions on the appropriateness of the items changed. Design: Repeated cross-sectional study. Setting: An online survey was sent to all Belgian OR professionals (nurses, surgeons, and anesthesiologists) in 2016 and 2021. Methods: Respondent characteristics were summarized using the proportions of discrete variables. Other data were analyzed using Pearson’s chi-squared test or Fisher’s exact test. A p-value (0.01) was considered statistically significant. Results: In 2021, participation increased from 1419 to 2166 OR professionals. More participants stated that they used SSC, and that its use was more systematic. Opinions about SSC revealed a significant change in patients’ appreciation of SSC use (more positive) and signs of a lack of knowledge of the patient file (less negative). More negative feelings were observed when the SSC was not used. The OR staff experienced less time pressure to complete the SSC. Surgeons, anesthesiologists, and colleagues exerted more pressure on SSC use. The pressure for not using the SSC was low. Seven of the 22 SSC components were judged more appropriate by 2021. ‘Time Out’ improved more than ‘Sign In’ or ‘Sign Out’. Team member introduction remained the least-supported component. Conclusion: SSC was used more often in 2021. Most of the opinions were positive. There was more pressure to use SSC. Most components were considered appropriate, except for team introduction. Local adjustments can align needs with the staff’s opinions. However, crucial components must be maintained.

Perioperative Death within 24 Hours: An Analysis of 2,000 Incident Reports of the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study

Background: Perioperative death is one of the indicators of anesthetic patient safety. The perioperative death rate has dramatically declined with the modern anesthetic techniques and perioperative medicine. Objective: To study contributing factors, factors minimizing incidents, and suggested corrective strategies. Materials and Methods: The present study was part of the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study, focusing on the incidents of perioperative death within 24 hours. The perioperative incidents from 22 tertiary hospitals across Thailand were gathered monthly. Two senior anesthesiologists reviewed the reports. Any discrepancy was solved by discussion for a consensus. Results: Of the first 2,000 incident reports in the PAAd Thai Study, there were 404 (20.2%) incident reports of 24 hours perioperative death. Extreme age of less than one year in 6.2% and more than 80 years in 8.2%, with ASA physical status of 3 or more in 97% while 51.2% occurred in the age group between 20 to 64 years. General anesthesia was the main anesthetic technique among fatal cases in 94.1% of the cases. Ninety-one cases (22.5%) occurred in the operating theatre with anesthesiology team witness. The high-risk surgeries with fatal outcomes were general surgery in 46.2%, cardiac surgery in 12.5%, neurological surgery in 11.6%, and endoscopic procedure in 3.2%. Exsanguination in 52.7%, particularly after traffic accident was the major cause of death followed by cardiac factors in 27.2%, and sepsis in 23%. Intraoperative death had higher proportion of exsanguination at 72.5% than postoperative death at 43% (p&lt;0.001). Postoperative death had higher proportion of sepsis-related death and brain death than intraoperative death at 27.5% versus 7.7% (p&lt;0.001), and 20.8% versus 5.5% (p=0.001), respectively. The factor-related death included Patient in 97.8%, Surgical in 42.3%, Anesthetic in 19.3%, and Systematic factors in 31.4%. Fatal causes were considered as preventable in 28.7%, particularly by surgical safety checklist in 18.1%. Conclusion: The multicenter study revealed a high proportion of 24 hours. perioperative death was commonly caused by exsanguination. Postoperative death was related to patient condition. Suggested corrective strategies were quality assurance activity, improved supervision, additional training, ICU availability, and more guidelines and compliance to guidelines including surgical safety checklists. Keywords: Mortality; Perioperative death; Incident report; Surgical safety checklists; Adverse event; Incident report

Improved safety and quality in intravascular brachytherapy: A multi-institutional study using failure modes and effects analysis

Highlight safety considerations in intravascular brachytherapy (IVBT) programs, provide relevant quality assurance (QA) and safety measures, and establish their effectiveness. Radiation oncologists, medical physicists, and cardiologists from three institutions performed a failure modes and effects analysis (FMEA) on the radiation delivery portion of IVBT. We identified 40 failure modes and rated the severity, occurrence, and detectability before and after consideration of safety practices. Risk priority numbers (RPN) and relative risk rankings were determined, and a sample QA safety checklist was developed. We developed a process map based on multi-institutional consensus. Highest-RPN failure modes were due to incorrect source train length, incorrect vessel diameter, and missing prior radiation history. Based on these, we proposed QA and safety measures: ten of which were not previously recommended. These measures improved occurrence and detectability: reducing the average RPN from 116 to 58 and median from 84 to 40. Importantly, the average RPN of the top 10% of failure modes reduced from 311 to 172. With QA considered, the highest risk failure modes were from contamination and incorrect source train length. We identified several high-risk failure modes in IVBT procedures and practical safety and QA measures to address them.

Common preventable errors in hand surgery: Analysis of NHS never events data and a proposed safety checklist.

Hand surgical procedures are common interventions in elective and emergency settings. The complex nature of the injuries and management by multiple specialities could be a potential source of medical errors and never events (NEs). Awareness of the common NEs could potentially help prevent their occurrence in the future. To analyse the NHS England database to identify the common NEs in hand surgery and present a simple, practical safety checklist for hand surgery. The NHS NEs database from 2012 to 2021 has been analysed to identify the common hand surgery-related never events. We identified the common categories and themes within. Our theme development process is based on anatomical considerations and the nature of the incidents. Additionally, we designed a simple Safety Checklist for hand surgery. We identified a total of 3742 never events with 50 incidents related to hand surgery, representing (1.3%). Wrong-site surgery was the commonest category (n =30), representing 60% of the hand surgery-related NEs. We identified seven different themes under wrong-site surgery. Wrong finger or digit surgery was the commonest theme, with 17 reported incidents representing 57% of wrong-site surgeries. This is followed by five wrong digits injections and three wrong k wire placements representing 16.6% and 10%, respectively. The second most common category was wrong incisions (n =15), representing 30%; 13 patients had wrong finger incisions. Two patients had carpal tunnel incisions before surgeons realised that the procedures were for trigger finger release.The third category included four wrong procedures, with two incidents of carpal tunnel release instead of trigger finger operation or Dequervain tendon release. Finally, one patient had an injection for carpal tunnel intended for another patient. Hand surgery-related NEs represent a small fraction (1.3%) of all NEs within the NHS database. We identified 50 hand surgery-related NEs arranged into 14 different themes. Additionally, we proposed a hand surgery-specific safety checklist to reduce the incidence of these incidents in the future.

AVOIDable medical errors in invasive procedures: Facts on the ground - An NHS staff survey.

Never Events represent a serious problem with a high burden on healthcare providers' facilities. Despite introducing various safety checklists and precautions, many Never Events are reported yearly. This survey aims to assess awareness and compliance with the safety standards and obtain recommendations from the National Health Service (NHS) staff on preventative measures. An online survey of 45 questions has been conducted directed at NHS staff involved in invasive procedures. The questions were designed to assess the level of awareness, training and education delivered to the staff on patient safety. Moreover, we designed a set of focused questions to assess compliance with the National Safety Standards for Invasive Procedures (NatSSIPs) guidance. Open questions were added to encourage the staff to give practical recommendations on tackling and preventing these incidents. Invitations were sent through social media, and the survey was kept live from 20/11/2021 to 23/04/2022. Out of 700 invitations sent, 75 completed the survey (10.7%). 96% and 94.67% were familiar with the terms Never Events and near-miss, respectively. However, 52% and 36.49% were aware of National and Local Safety Standards for Invasive procedures (NatSSIPs-LocSSIPs), respectively. 28 (37.33%) had training on preventing medical errors. 48 (64%) believe that training on safety checklists should be delivered during undergraduate education. Fourteen (18.67%) had experiences when the checklists failed to prevent medical errors. 53 (70.67%) have seen the operating list or the consent forms containing abbreviations. Thirty-three (44%) have a failed counting reconciliation algorithm. NHS staff emphasised the importance of multi-level checks, utilisation of specific checklists, patient involvement in the safety checks, adequate staffing, avoidance of staff change in the middle of a procedure and change of list order, and investment in training and education on patient safety. This survey showed a low awareness of some of the principal patient safety aspects and poor compliance with NatSSIPs recommendations. Checklists fail on some occasions to prevent medical errors. Process redesign creating a safe environment, and enhancing a safety culture could be the key. The study presented the recommendations of the staff on preventative measures.

146 WHO Surgical Checklist Compliance and Attention Rates Among Different Specialties and Years

Abstract Aim This study aims to evaluate the compliance of surgical staff to the WHO surgical safety checklist, excluding sign-out. The quality of surgical marks and inattentive rates of surgical staff during me-out were also investigated. Method Data was collected over 3 weeks using a fixed criteria in September 2022 within 3 hospitals consisting of 5 sites. A total of 105 procedures were observed. Mean and confidence intervals were calculated using SPSS. Results The mean compliance rate of the checklist was 97%. Sign-in (97%), Time-Out (96%), and Surgical mark rates (98%) all scored similarly. Among specialties observed, interventional cardiology scored the highest compliance rates, at 100%, while cardiothoracic surgery scored the lowest at 91%. In 38% of procedures observed, surgical staff were found to be inattentive during me-out. Among the inattentive surgical staff, 73% of surgical staff had mild inattentiveness (e.g. filling up drug charts), 18% had moderate inattentiveness (e.g. talking to other staff), 9.1% of them had severe inattentiveness (e.g. scrubbing in). Among the audit cycles from 2014 to 2022, there was an increase in sign-in rates from the previous cycle held in 2019 to 2022 from 82% to 97%. Inattentive rates increased from 33% in 2019 cycle to 38% in 2022 cycle. Conclusions This study reports high compliance rates and improvement with the checklist among all specialties, but also high inattentive rates by surgical staff. Improvements such as fostering a good culture among surgical staff on the WHO checklist and paying attention are key in never reducing events.

Epidemiology of Occupational Injuries and Workplace Assessment in Turnery Industries at an Industrial District, Eastern Cairo, Egypt

Background Occupational injury could be fatal or non-fatal with lost work time. Turneries are workplaces in which multiple simultaneous health hazards occur and the most common hazards are mechanical hazards. Objective To measure the frequency and types of injuries among a sample of turnery workers, to identify risk factors of occupational injuries among them, and to describe the environmental conditions at some of these turneries as a part of occupational safety prospective. Methods A cross-sectional survey was conducted on 75 workers in three Industrial areas in Eastern Cairo El-herafeen, Madinat Al-salam and El-Abour. Data were collected using a structured interview questionnaire with both close and open-ended questions, and an observational environmental checklists were filled by the researcher. Results Seventy-five turnery workers were interviewed, (76%) of them reporting injury during the last 12 months. About (46.7%) of operators believing that their work is extremely dangerous. The most significant determinants for occupational injuries (p value &amp;lt; 0.05) were lack of safety training, non-use of personal protective devices and work hazard perception. In environmental assessment, all work stations had non-covered traditional machines, only 2 work stations out of 10 assessed had natural ventilation with open windows; not any of the work stations had regular noise survey neither did any of the workers use hearing protection equipment even though it was available in 2 work stations; only 4 work stations had floors free from protruding nails, splinters, holes and loose boards, goggles were available in 4 stations while gloves and rubber boots were available in 6 stations. Conclusion Most of workers in small scale work stations specialized in turnery industry had occupational injury during the last 12 months. Most of the observed workstations did not comply with advised safety checklist.

307 Intraluminal Migration of Gossypiboma and rectal expulsion an unusual Case- Case Report

Abstract Background Gossypiboma refers to foreign body retained in the body at the end of operation and can be in the form of gauze, sponge or any form of textile resulting in grave consequences for both the patient and the surgeon. Case Summary A 23-year-old female presented with complain of generalized abdominal pain along with non-bilious vomiting since 10 days. She also had relative constipation since four days. Her past surgical history was unremarkable except for three elective lower segment caesarean sections at another hospital. Upon abdominal examination, she had a scar of pfannenstiel incision along with 3x4 cm swelling in umbilical region with positive cough impulse. Her bowel sounds were exaggerated. DRE was unyielding. Clinical diagnosis of subacute intestinal obstruction was made and she was managed conservatively. Ultrasound abdomen showed dilated gut loops with hyperperistalsis. It also revealed a defect measuring 8.5 cm in the supraumbilical region of anterior abdominal wall through which fat content was seen protruding. She was advised contrast enhanced CT abdomen, developed diarrhoea and later on expelled the surgical sponge per rectally. After passage of surgical sponge, condition of patient improved and symptoms resolved. Discussion Diligent efforts are required to prevent this human error by ensuring meticulous sponge count, use of radio-opaque sponges, adjunctive use of WHO safety checklist and introduction of new advancements like tagging system in our healthcare system. Conclusion Gossypiboma is under-reported due to reluctance of institutions to report it to governing body. Reporting of such dreadful complications of surgery and analysis of their root cause should be done to prevent such events from happening.