Surgical Safety Checklist Research Articles

Unlocking Insights: Exploring Knowledge and Attitudes on the WHO Surgical Safety Checklist among Operating Room Personnel in Police and Services Hospital, Peshawar, Pakistan

Background: The World Health Organization's Surgical Safety Checklist (SSC) has been identified as a pivotal tool for enhancing patient safety in operating rooms globally. Despite its proven efficacy, varying levels of knowledge and attitudes towards the SSC among healthcare professionals can influence its successful implementation. Objective: This study aimed to evaluate the knowledge and attitudes of operating room personnel towards the SSC at the Police and Services Hospital (P&SH) in Peshawar, Pakistan, identifying gaps and areas for improvement to facilitate better adoption and utilization of the SSC. Methods: A cross-sectional survey was conducted from November 2023 to January 2024 among 30 permanent staff members in the operating theaters at P&SH, including surgeons, nurses, anesthetists, and technicians. Participants were selected using convenience sampling. The survey comprised demographic questions, knowledge-based questions regarding the SSC, and items assessing attitudes towards the checklist. Data were analyzed using descriptive statistics to summarize demographic information, knowledge levels, and attitudes. Results: The study found that 93.3% of participants had heard of the SSC, with 93.3% demonstrating good knowledge and a positive attitude towards its implementation. However, 3.3% of the participants displayed poor knowledge, and a small fraction exhibited neutral or negative attitudes (6.7%). A significant majority (93.3%) expressed strong support for using the SSC in all surgical procedures, while concerns were raised about its potential to waste time and impact operating efficiency negatively. Conclusion: The high level of awareness and positive attitudes among operating room personnel at P&SH towards the SSC is encouraging. Nevertheless, the presence of knowledge gaps and efficiency concerns highlights the need for targeted educational interventions and strategies to address misconceptions and operational challenges. Enhancing the understanding and efficient use of the SSC can further solidify its role as a cornerstone of patient safety in surgical settings.

The ritualisation of the surgical safety checklist and its decoupling from patient safety goals.

Patient harm, patient safety and their governance have been ongoing concerns for policymakers, care providers and the public. In response to high rates of adverse events/medical errors, the World Health Organisation (WHO) advocated the use of surgical safety checklists (SSC) to improve safety in surgical care. Canadian health authorities subsequently made SSC use a mandatory organisational practice, with public reporting of safety indicators for compliance tied to pre-existing legislation and to reimbursements for surgical procedures. Perceived as the antidote for socio-technical issues in operating rooms (ORs), much of the SSC-related research has focused on assessing clinical and economic effectiveness, worker perceptions, attitudes and barriers to implementation. Suboptimal outcomes are attributed to implementations that ignored contexts. Using ethnographic data from a study of SSC at an urban teaching hospital (C&C), a critical lens and the concepts of ritual and ceremony, we examine how it is used, and theorise the nature and implications of that use. Two rituals, one improvised and one scripted, comprised C&C's SSC ceremony. Improvised performances produced dislocations that were ameliorated by scripted verification practices. This ceremony produced causally opaque links to patient safety goals and reproduced OR/medical culture. We discuss the theoretical contributions of the study and the implications for patient safety.

Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklist

Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklist

Does the WHO Surgical Safety Checklist Need Modification for Orthopaedic Surgery Practices? A Cross-Sectional Survey Among Indian Orthopaedic Surgeons.

It is well known that the implementation of the WHO surgical safety checklist (SSC) leads to improved operating room team coordination and reduced perioperative complication and mortality rates. Although it is proven to be beneficial worldwide, its awareness and usage need to be evaluated in a diverse country like India. As orthopaedic surgeries involve implants and tourniquet usage, it is important to evaluate the applicability of WHO SSC specifically to orthopaedic surgeries, and whether any modifications are needed. A web-based cross-sectional survey was conducted among Indian Orthopaedic Surgeons with a pre-defined questionnaire regarding awareness, usage and suggestions to modify the existing WHO SSC (2009) for orthopaedic surgeries. 513 responses were included for final analysis. 90.3% of surgeons were aware of the surgical safety checklist; however, only 55.8% used it routinely in their practice. The awareness of SSC availability was 1.85 times more among younger surgeons (< 20years of experience) than among those with > 20years of experience. 17% of surgeons thought the usage of SSC was time-consuming and 52.4% of participants felt a need to modify the existing WHO SSC (2009) for orthopaedic surgeries. 34.5% recommended the inclusion of the patient blood group in the "Sign-in" section, 62.77% proposed the inclusion of details about the tourniquet, whereas only 6.63% suggested adding about surgical implant readiness in the "Time-out" section and 72.7% suggested including a check to make sure the tourniquet was deflated, removed and also recording of the total usage time during the "Sign-out" section. Despite high (90%) awareness among Indian Orthopaedic surgeons, they have limited usage of the WHO SSC in their practice. Identifying barriers and considering modifications for orthopaedic surgeries, like details about tourniquet usage during the "Time-out" section and a check to ensure it was removed during the "Sign-out" section, will improve patient safety and outcomes. The online version contains supplementary material available at 10.1007/s43465-024-01096-5.

Safety Checklist: Practical Application in a Multidisciplinary Hospital Setting

The relentless improvement of medical care does not exclude the presence of certain complications in patients during the implementation of their treatment. This may be facilitated by the complexity of the manipulations and operations performed, the possibilities of new technologies, the age and concomitant pathology of patients. The predominant occurrence of adverse consequences in the provision of surgical care has prompted the medical community to pay attention to this in the first place. In the process of searching for a simple tool to solve problems arising in the provision of surgical care, a Surgical Safety Checklist (checklist, SSC) was created at the initiative of the World Health Organization (WHO). Its introduction into standard practice in operating rooms was aimed at improving the safety of both anesthesia and surgical operations, as well as reducing complications and mortality by improving teamwork, communication and consistency of medical care. The purpose of this message is to focus the attention of specialists from various fields and ranks on the need to introduce SSC into the daily work of a multidisciplinary hospital in the form of a standardized procedure for the effective functioning of the operating unit team, the ultimate goal of which is to provide safe care to the patient. An analysis of 4 years of experience in the use of SSC in the Ilyinskaya Hospital allows us to talk about the difficult process of staff entering the workflow of using a seemingly elementary tool. However, the improvement of communication processes and the adaptation of both the mechanism of SSC implementation and its contents allow us to hope for its strict observance and, ultimately, a significant reduction in all possible avoidable risks during the provision of surgical care.

Surgical Safety Checklist as an optimal organizational model in ensuring the maximum degree of preparedness for intraoperative incidents (case report)

Objective. The use of checklists for quality and safety control of medical care is an effective tool for reducing the frequency of errors, dangers and complications in any section of medical practice.The aim is to demonstrate the possibilities of minimizing and leveling the potential risks accompanying surgical intervention using the example of routine application of the surgical safety checklist.Object and methods. Patient A., 55 years old, was admitted to the emergency department of Samara City Clinical Hospital №1 named after N.I. Pirogov on 24.04.2023. with complaints of pain in the right upper abdomen, nausea, vomiting, general weakness. The diagnosis was Cholelithiasis, acute calculous cholecystitis with the formation of a perivesical abscess. It required laparoscopic cholecystectomy operation. While filling in the surgical safety checklist (SSC) and analyzing possible intraoperative incidents, the attending physician executed an informed voluntary consent for transfusion of donor blood components. The corresponding components were ordered. Having weighted up the potential intraoperative risks specified in the part "Before anesthesia" of SSC, the anesthesiologist installed a catheter into one of the central veins and performed the urine bladder catheterization. Surgical intervention was complicated by bleeding, which required conversion of surgical approach. Upper median laparotomy, cholecystectomy, surgical hemostasis were performed. Total blood loss was 1000 ml, plasma and red blood cell were donated to the patient. The operation was completed by drainage of the subhepatic space and suturing of surgical wounds.Results. The clinical case describes the importance of a team approach at the stage before the operation, as well as the role of all specialists provided life support and medical care for the patient. It results from attentive work with the checklist which shows a clear liability for each member of the operating team at different stages of preparation and treatment of a surgical patient.Conclusions. The development of a culture of surgical safety is an important way to minimize the risks associated with surgical intervention for each individual patient and for the institution by optimizing the work of operating units.

The Relevance of World Health Organization Surgical Safety Checklist to Spinal Surgery

Across the 193 member states of the World Health Organization (WHO) an estimated 234 million operations were conducted worldwide in 2008 (1 per every 25 human beings on the planet). These numbers have continued to increase to 312.9 million by 2016. Surgical errors involving the wrong site, wrong procedure or wrong patient occur at a rate of 1 in 112,000. This equates to 2,000 estimated ‘never events’ every year with a significant associated physical and psychological burden on patients and surgeons and financial and reputational burden on health organisations involved in litigation for such errors. The WHO Surgical Safety Checklist (WHOSSC), produced in 2009 is now synonymous with safety in the operating theatre. This checklist imposes a process of scrutiny at the key steps of the patients journey through theatre. The key details scrutinised have been shown to improve patient outcomes and theatre efficiency. Several studies have looked at adapted checklists specific to different specialties and it is becoming clearer that whilst the overall benefit of the original checklist is undeniable, in some speciality areas a more deliberate and nuanced application of the checklist to address specific problems could be of value. As a specialism, spinal surgery differs from others with a significant risk of a perioperative complication leading to harm and morbidity, permanent disability or even death. Iatrogenic spinal cord injury requires high-level resources and prolonged, sometimes lifelong rehabilitation. Other complications include cerebrospinal fluid leak, blood loss, new neurologic deficit, hardware failure, proximal junctional failure, pseudarthrosis, and surgical site infection. Wrong level spinal surgery (WLSS) is a complication specific to spinal surgery and studies have reported WLSS effecting 50-68% of spinal surgeons at some point in their career. The risks of these complications can be mitigated by factors, some of which are included in the WHOSSC and others with are lacking. This scoping review looks at how surgical checklists; both the original and modified versions have and could be used to address the surgical safety challenges specific to spinal surgery.

Audit of the use of WHO surgical safety checklist and assessment of attitudes towards it among surgical team personnel in a Tertiary Hospital in Nigeria

Introduction: The World Health Organization (WHO) Surgical Safety Checklist (SSC) launched in 2009 was developed to address preventable causes of morbidity and mortality in the perioperative period by promoting communication among all team members and ensuring that all necessary safety checks are done as and when due and that they are done appropriately. Studies have shown that implementation of the WHO checklist reduces the risk of SSI and preventable deaths by about 50%. Thus, it is encouraged that all hospitals, domesticate the tool to improve patient safety. The study aims to assess the level of usage of the WHO SSC, the gaps in its implementation and to evaluate the awareness, perception and acceptability of this tool among theatre staff personnel at a tertiary hospital in Nigeria. Materials and methods: We prospectively conducted an audit of the use of the WHO SSC at the main and emergency theatres, University College Hospital, Ibadan by observing the level of implementation of the different events in the WHO SSC using a pre-developed questionnaire. We subsequently conducted a survey on the awareness, perception and acceptability of the WHO SSC among the operating team personnel using a 15-item self-administered questionnaire. The data were analysed with SPSS. Results: A total of 117 surgeries were observed during the audit and 81 surgical team personnel took part in the survey. The WHO SSC was used in about half (52.1%) of the surgeries and it was sparingly used during minor surgeries (5.4%). The Sign Out Phase was the least completed phases of the checklist. The personnel administering the check list (usually the circulating nurse) did not ask the scrub nurse the required questions in more than half of the time (53.1–58.7%) in the Time Out Phase and this was significantly higher when compared with unasked questions to other professionals of the team (11.3–15.6%). In the Sign Out Phase, of the five questions, four questions were barely asked in about half of the time (44.6–76.8%). Eighty-one per cent personnel were surveyed, half (50%) were surgeons and about a quarter were anaesthetists (23%) and Nurses (27%). More than half of respondents (58%) have more than 5-year work experience in the hospital. Majority (65.4%) of members of the surgical team had not had any formal training on the WHO SSC. About a third of respondents (28%) who had made an error in surgery agreed that it could have been prevented by proper implementation of the WHO SSC. The respondents also agree that the sign out phase was completed in less than a third (27.2%) of the time. There was no difference in its awareness, perception and acceptability based on profession of the respondents. Conclusion: The WHO SSC should be made available at all theatres in the hospital and should be administered during all surgeries. There should be more formal training of members of the surgical team to improve implementation. Assessing for the barriers to the implementation of the WHO Safety Surgical Checklist is the logical next step to improve the use in our theatre.

Experiences of University College Hospital, Ibadan surgical residents in audit and research

An online monthly seminar was started in April 2021 for surgical residents at the College of Medicine University of Ibadan by a faculty of alumni based in the United Kingdom. The surgical residents felt the seminars will make them better clinicians, fill gaps in their training and find out about Gold Standards of care. Moodle learning management system was used to manage course materials, communication, feedback, online surveys, and interaction with trainees. Seventy-two residents registered, but only about 30 were core attendees. All recorded lectures were placed on You Tube https://www.youtube.com/playlist?list=PLXzLiMlwy2sjLAacZLav58h7aj7qXZaWZ. Topics were multispecialty and determined by the residents. At the same time, an audit-and-research group (ARG) was formed, with eight residents joining. This number has risen to 14. The ARG was a response to a survey assessing residents’ experiences in research and audit. Thirty-seven surgical residents, with an average age of 34.3 years, completed the questionnaire. Forty-three per cent were senior residents and 84% were males. Forty-three percent were general surgery residents, 16% orthopaedics and 11% in urology, 8% in neurosurgery and 8% in paediatric surgery, The rest were from plastic, ENT and cardiothoracic surgery. The median number of years from graduation was 9 years with an inter-quartile range of 7–11 years. Sixty-five per cent of residents had not done any audit since graduation, and only 24% had completed an audit cycle. All residents agreed that surgeons should do audits, and all agreed that it was good for clinical practice. Ninety-five per cent agreed that surgeons should do a least an audit annually, however, only 68% of residents indicated that they would like to do an audit. Eighty-one per cent of residents had never presented an audit or research work, oral or poster, at a national or international meeting, and 65% have never been an author in a peer-reviewed article. Ninety-seven per cent indicated that they would like to take part in a study. The six top reasons given for poor audit and research outputs by the residents were (multiple answers allowed): Not knowing where to start by 60% of surgical residents No support for it by 46% No source of funding by 38% Audit and research is not a culture in their environment by 38% No opportunities by 24%. No suitable role models by 16% After completion of training, 76% of residents indicated that they wanted to work in a teaching hospital. In two and half years since its formation, the ARG has completed a qualitative study on clinical learning environments (OP05) and an audit on the use of WHO surgical safety checklists in theatre (OP06). These were supervised by both a local faculty and a UK-based alumnus. These have generated two oral and one poster presentations at international conferences.

Assessment of Knowledge and Attitude Regarding World Health Organization (WHO) Surgical Safety Checklist (SSC) in Operating Room Personnel of Medical Teaching Institutes (MTIS) Peshawar Pakistan

Background: World health organization surgical safety checklist is basically the guideline for the operating room personnel. These guidelines are properly started by WHO in 2007-8. The purpose was to improve the outcomes of the surgical procedures, communication, decline the mortality and morbidity ratio perioperatively. Using WHO checklist plays a very important significant role in patient safety especially in perioperative time. One study shows that about 47 % reduction occur in mortality and 36 % in morbidity while using the SSC. In the developed countries having proper safety system and knowledge complication rate was reported 0.4 to 0.8% while in the developing countries this ratio was about 3 to 16 % (2004 report). Objective: To Assess the knowledge and attitude regarding WHO SSC of operating room personnel of MTIs Khyber teaching hospital (KTH) and Hayat Abad medical complex (HMC) of Peshawar Pakistan. Methods: Cross sectional study conducted. Data collected through semi structured questionnaire from operating room personnel including surgeons, anesthesia provider, surgical technician, technologist, and OT nurses working in MTI KTH and MTI HMC. Results: According to the study about 30(14.6%) OT personnel having good knowledge,115(56%) having average and 60(29.2%) of personnel having poor knowledge regarding WHO SSC. The result of the attitude of OT personnel regarding safety checklist was 141(6.7%) positive means they agreed with WHO rules and want them to be implemented in the OT while 64 (31.2%) showed negative attitude. Conclusion: Adverse events are common in the preoperative period. This is due to poor organizational, limited, knowledge respect less attitude of the staff toward their duty, and patient self-mistakes. But the great responsibility of the staff is to care for the patient in the proper while according to the rules and regulation set by the WHO in the form of surgical safety checklist. By using safety checklists properly, the adverse events can minimize up to a great number. For the best result the personnel must have proper knowledge, awareness, importance and need of practical implementation. By default, our health system is still going on previous knowledge base and not properly adjusted in the advanced system. In these two hospitals most of the HCPs are not aware of the importance of the WHO checklist and some are against the practical implementation of the checklist. This is an amazing and questionable point that can be overcome through education.

A Bibliometric Analysis of the Surgical Safety Checklist: Trends, Impact and Future Directions

A Bibliometric Analysis of the Surgical Safety Checklist: Trends, Impact and Future Directions

P149 Improving compliance with the World Health Organisation Surgical Safety Checklist

P149 Improving compliance with the World Health Organisation Surgical Safety Checklist

Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments

Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Implementation of the refined Clean Cut program. The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.

Knowledge, attitudes, beliefs and practices of the WHO surgical checklist in neurosurgery at a quaternary referral hospital, Durban, South Africa

BackgroundDespite an established WHO surgical safety checklist (SSCL) at the referral hospital in Durban, ‘‘Never Events’’ still occur. Observations suggest that many surgical team members are unaware of SSCL existence, those who knew about it are not convinced that it prevents errors, reduces morbidity and mortality and tend not to use it. ObjectivesThe study aimed to establish the knowledge, attitudes, beliefs and practices regarding the SSCL and its use among the neurosurgical staff at a quaternary referral hospital in Durban, South Africa. MethodsQuestionnaires were distributed to neurosurgical theatre staff at the referral hospital in Durban. Data collected included their awareness, beliefs, attitude and practices regarding the SSCL. Data collected were analysed using R Statistical computing software of the R core Team, 2020. ResultsOf the participants that responded, 97% had knowledge of SSCL, 84% knew where it is, 86% believed that it was easily accessible, 96% knew why and 90% knew when to use it. All agreed that the SSCL is a crucial safety tool. Majority believed that SSCL prevents perioperative adverse events, is not time consuming, is not a useless tool, does not increase the workload and does not make patients anxious. ConclusionResults show that most surgical teams know of WHO SSCL. The negative attitude of staff towards SSCL is a significant factor in most of the studies in deterring effective implementation and use. The majority of the study participants believe the SSCL is an essential surgical safety tool useful in preventing errors, morbidity and mortality.

Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia.

Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia.

Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist

Patient safety interventions, like the World Health Organization Surgical Safety Checklist, require effective implementation strategies to achieve meaningful results. Institutions with underperforming checklists require evidence-based guidance for reimplementing these practices to maximize their impact on patient safety. To assess the ability of a comprehensive system of safety checklist reimplementation to change behavior, enhance safety culture, and improve outcomes for surgical patients. This prospective type 2 hybrid implementation-effectiveness study took place at 2 large academic referral centers in Singapore. All operations performed at either hospital were eligible for observation. Surveys were distributed to all operating room staff. The study team developed a comprehensive surgical safety checklist reimplementation package based on the Exploration, Preparation, Implementation, Sustainment framework. Best practices from implementation science and human factors engineering were combined to redesign the checklist. The revised instrument was reimplemented in November 2021. Implementation outcomes included penetration and fidelity. The primary effectiveness outcome was team performance, assessed by trained observers using the Oxford Non-Technical Skills (NOTECH) system before and after reimplementation. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to assess safety culture and observers tracked device-related interruptions (DRIs). Patient safety events, near-miss events, 30-day mortality, and serious complications were tracked for exploratory analyses. Observers captured 252 cases (161 baseline and 91 end point). Penetration of the checklist was excellent at both time points, but there were significant improvements in all measures of fidelity after reimplementation. Mean NOTECHS scores increased from 37.1 to 42.4 points (4.3 point adjusted increase; 95% CI, 2.9-5.7; P < .001). DRIs decreased by 86.5% (95% CI, -22.1% to -97.8%; P = .03). Significant improvements were noted in 9 of 12 composite areas on culture of safety surveys. Exploratory analyses suggested reductions in patient safety events, mortality, and serious complications. Comprehensive reimplementation of an established checklist intervention can meaningfully improve team behavior, safety culture, patient safety, and patient outcomes. Future efforts will expand the reach of this system by testing a structured guidebook coupled with light-touch implementation guidance in a variety of settings.

Health care professionals most relevant phrases used in a digital medical translation tool in 24-7 communication with minority speaking heart surgery patients during hospitalization

Abstract Background/Introduction Health care professionals’ communications with hospitalized minority speaking heart patients are even in 2023 still frequently limited to non-verbal language, notes from informal caregivers and "google translate" in situations where interpreters are not available. Health care based digital solutions aiding translation may help improve health care professionals’ assessment, information about and treatment of minority speaking patients, and there is an urgent need for innovative research into this area. Purpose To describe the most relevant phrases used by health care professionals’ in a digital, medical translation tool for 24-7 communication with minority speaking heart surgery patients during hospitalization. Methods A digital medical translation tool was customized using the internationally recognized ABCDE (Airway, Breathing, Circulation, Disability, Exposure) systematic approach to assess and treat, in addition with the pre-operative surgical safety checklist employed as a framework. Health care professionals’ use of phrases in the digital tool when communicating with the minority speaking heart surgery patient’s during their clinical hospital pathway (Figure 1) were then counted, categorized, and finally linked to health care professionals’ actions. Results Fifty-five health care professionals (i.e. registered nurses, intensive care nurses, operating room nurses, anaesthesia nurses and physiotherapists) were during 60 shifts with 24-7 follow-up of five minority speaking heart surgery patients using a total of 410 phrases from the digital medical translation tool. The phrases were categorized and counted into the ten most common categories (Figure 2): 1. Pain (e. g. are you in pain?), 2. Nutrition (e. g. are you hungry?), 3. Respiration (e.g. breathe in), 4. Mobilisation (e.g. you have to get up and stand), 5. Psychological support (e.g. the surgery went well), 6. Safe surgery (e.g. do you have any teeth that are loose?), 7. Medications (e.g. pain relievers), 8. Communication (e.g. just answer "yes" or "no"), 9. Examination (e.g. you are going to have an x-ray examination), 10. Circulation (e.g. do you feel dizzy?). Health care professionals’ actions (i.e. assessment, information and reassurance, and instructions) were categorized and related to these phrases. Conclusions A health care based digital medical translation tool can aid in communication with minority speaking patients in situations when interpreters are not available. This study shows how health care professionals’ use of such a translation tool when communicating with minority speaking heart surgery patients during hospitalization can employ phrases and categories 24-7 to improve patients’ healthcare.Fig.1 Clinical pathwayFig.2 HCP communication

Safety and safety protocols for living donor nephrectomy in Italy

Living donor kidney transplantation (LDKTx) is recommended by all scientific societies. Living donor nephrectomy (LDN) is probably one of the safest surgical procedures, but it carries some risk for healthy donors. The aim of this study is to provide a snapshot of LDKTx activities in Italy and ask about safety measures implemented in LDN. Data on LDKTx were extracted from the national database. Safety measures were examined through a specific survey. Between 2001 and 2022 40,663 kidney transplants (31.4 per million population-pmp) were performed, including 4731 LDKTx (3.7 pmp). There was no postoperative death of the donor. After a median follow-up of 52.2 months [IQR:17.9–99.5], the 10-year donor survival rate was 93.38% (CI:97.52–98.94). There was evidence of renal disease in 65 donors (1.8%), including 42 (1.1%) with stage III end-stage renal disease. Twenty-nine out of 35 transplant centers (TC) involved in LDKTx responded to the survey (82.9%). Six TCs (21.4%) had a total experience of 20 or fewer LDN. Minimally invasive LDN was the first choice at 24 TC (82.8%). At 10 TC (37.0%) only one surgeon performed LDN. Nineteen TCs (65.5%) had a surgical safety checklist for LDN and 14 had a postoperative surveillance protocol. The renal artery was occluded in 3 TCs (10.3%) mainly by non-transfixion methods (including clips). Redundancy of key safety systems in the operating room was available in 22 of 29 centers (75.8%). In summary, LDKTx should be further implemented in Italy. Donor safety should be improved through the implementation of a national procedural protocol.

Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi

BackgroundThe WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of...

Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project

BackgroundIn 2009, the WHO introduced the surgical safety checklist (SSC) as one of the interventions for improving patient safety. The systematic use of structured checklists during surgery has been shown...