WHO Surgical Safety Checklist Research Articles

Assessing use of the WHO surgical safety checklist for pediatric surgery in Senegal: A nationwide survey

Introduction The World Health Organization (WHO) introduced the surgical safety checklist (SSC) to reduce postoperative morbidity and mortality; however, its use in low- and middle-income countries is still low. Methods We conducted a survey from January 2 to 22, 2024, in public hospitals’ pediatric surgery departments and units in Senegal to assess the use of the WHO SSC or an adapted version. Results The participation rate was 100% (23 hospitals), with 11 second-level hospitals (47.8%) and 10 (43.5%) having at least two pediatric surgeons. All hospitals had an anesthetist nurse, and 18 hospitals (78.3%) had at least two scrub nurses. For the surgical workload, 14 hospitals (60.9%) had five to 10 surgical interventions weekly. Eleven hospitals (47.8%) had training on use of the SSC, and 8 of the 23 hospitals (34.8%) used the SSC. The WHO SSC nonutilization was mainly due to a lack of training in nine hospitals (60%) and SSC unavailability in five hospitals (33.3%). Members of 22 hospitals (95.6%) were available for training on use of the SSC. Conclusion The WHO SSC is poorly used in pediatric operating rooms of public hospitals in Senegal. The main reasons for nonutilization are remediable.

Implementation of the WHO surgical safety checklist in resource-limited Somalia: a new standard in surgical safety

BackgroundSurgical safety remains a critical global health concern, with complications from surgical procedures resulting in significant morbidity and mortality, particularly in low- and middle-income countries. The World Health Organization (WHO) Surgical Safety Checklist (SSC) has been shown to reduce surgical complications and mortality rates. However, its implementation and impact in resource-limited settings like Somalia remain understudied. This study aimed to evaluate the implementation of the WHO SSC in selected hospitals in Mogadishu, Somalia, and assess its impact on surgical safety practices.MethodsA pre- and post-intervention study was conducted in 15 randomly selected hospitals in Mogadishu, Somalia. The intervention involved a comprehensive training program on the WHO SSC for surgical teams. Data on hospital characteristics, surgical details, and adherence to the SSC were collected over two periods: pre-intervention (April 12th to May 4th, 2024) and post-intervention (May 12th to June 3rd, 2024). The primary outcome was the adherence to the SSC, categorized as good (> 60%) or poor (≤ 60%). Descriptive statistics, McNemar’s test, and binary logistic regression were used for data analysis.ResultsAdherence to the WHO SSC significantly improved post-intervention, with 98.8% of surgical cases demonstrating good adherence compared to 37% pre-intervention (p < 0.001). The mean adherence score increased from 51.6% (SD = 29.6) to 94.1% (SD = 8.2). Significant improvements were observed for most individual checklist items, including patient identity confirmation, surgical site marking, anesthesia machine checks, and pulse oximeter use (p < 0.001). Team dynamics and communication also improved significantly post-intervention. Hospital type, size, years of service, funding source, surgical department, surgery type, urgency, and staff numbers were associated with checklist adherence pre-intervention.ConclusionThe implementation of a comprehensive training intervention significantly improved adherence to the WHO Surgical Safety Checklist in resource-limited hospitals in Mogadishu, Somalia. The findings highlight the feasibility and effectiveness of the SSC in enhancing surgical safety practices, team communication, and patient outcomes in challenging healthcare environments. Tailored implementation strategies, ongoing training, and cultural adaptation are crucial for the successful adoption of the SSC in resource-constrained settings.

Perioperative mortality of caesarean section in North-West Ethiopia: a prospective cohort study

ObjectiveThis study aimed to assess 7-day perioperative maternal mortality and risk factors at Tibebe Ghion Specialized Hospital.DesignA single-centre prospective cohort study.SettingA tertiary hospital in North-West Ethiopia, 01 June 2019 to...

WHO Surgical Safety Checklist compliance rate at a large tertiary hospital in Vietnam.

The WHO Surgical Safety Checklist has been instrumental in reducing surgical deaths by 47% globally since its inception in 2009. A study was conducted to assess the compliance of hospital staff with the Surgical Safety Checklist and identify potential barriers to its implementation at a large tertiary public hospital in Vietnam. The study analysed 135 surgical cases between February and September 2021 using the Pareto principle with eight error categories, including (1) patient identification, (2) equipment, (3) risk management, (4) blood loss, (5) allergy, (6) items left inside the patient, (7) surgical specimens and (8) patient safety and recovery management. Compliance with the Surgical Safety Checklist was between 77% and 93%, with five categories accounting for more than 80% of errors. Periodic monitoring and staff training can improve compliance and help reduce errors for better patient safety. Long-term solutions addressing infrastructure challenges are also crucial.

FP6.10 - Improving Compliance &amp; Implementation of WHO Surgical Safety Checklist At a Tertiary Level Hospital in India: A continuous process

Abstract Aim To complete an audit on the level of compliance with the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India. Method A total of 40 general surgeries were observed at the operating theatres at a tertiary-level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for 1 month in September 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out through a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted. Results Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80%, and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Compliance in the final third cycle showed improvement in Sign-In at 95%, Sign-Out at 85%, and Time-Out at 90%. Conclusion Though in the first cycle of our audit, the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle and eventually in the final third cycle bringing it closer to 100% compliance, after rigorous awareness programs and training sessions. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for the successful implementation of the Surgical safety checklist.

EP335 - Audit of the Use of WHO Surgical Safety Checklist and its Awareness, Perception and Acceptability Amongst Theatre Personnel in a Tertiary Hospital in Sub-Saharan Africa

Abstract Aims The World Health Organization Surgical Safety Checklist (SSC) was developed to prevent perioperative adverse events. This study aimed to assess the utilization of the SSC and evaluate awareness and acceptability among theatre staff at a tertiary centre in sub-Saharan Africa. Methods We conducted a prospective audit of the SSC utilization during elective and emergency surgery, and a survey of awareness, perception and acceptability amongst theatre personnel (nurses, surgeons and anaesthetists) using a 15-item self-administered questionnaire between May 2022 and January 2023. Results 117 surgeries were observed for compliance with SSC and 81 theatre personnel took part in the survey. The checklist was used in 52.1% of all surgeries, 80% and 5.4% of major and minor surgeries respectively. In Time Out phase, activities were stopped in 23% of cases, and scrub nurses were asked relevant questions 31-47% of the time. Sign Out was the least completed phase. Three of five questions were asked 23-48% of the time. 28% of respondents who previously witnessed adverse events agreed that they could have been prevented by proper implementation of the SSC. 65.4% of members of the surgical team had not had any formal training on the SSC. There was no difference in its awareness, perception and acceptability based on profession of the respondents. Conclusion SSC was not fully utilized during the audit period. Lack of formal training may be contributory. There is broad awareness of SSC and its ability to prevent advert events. Key words: WHO, Surgical Safety Checklist, Awareness

A crucial step towards a safer healthcare system: Embracing the WHO surgery checklist in Pakistan.

Mistakes happen. We all make mistakes that makes us human. But when a surgeon makes mistake, it costs lives. Being surgeon, a little negligence might make catastrophic incidents happen. An unintentionally retained needle in the abdominal cavity or surgery of a normal limb instead of faulty gall bladder can have serious consequences not only for the patient and the patient-physician relation but also for the healthcare system. Such negligence events have become common in Pakistan. In Faisalabad, it was reported that a patient with gall stones was mixed up with a patient of limb surgery having the same name that led to inappropriate surgical procedures performed on both.[1] In Abbottabad, an incident was reported where the patient had to undergo an arm surgery but an eye surgery was performed in a private hospital. [2] Everyone blamed the surgeon and the health care system but no one dared to dig into the cause. Why are such childish mistakes happening? And if happened once how is this being repeated? How could a surgeon, a practically learned man make such non-sense? The answer to all these questions lies in the WHO Surgical Safety Checklist. “Safe Surgery Save Lives” was initiated by the World Health Organization (WHO) in 2007 in order to alleviate the number of such unwanted events encountered in the surgical procedures. For the purpose of improving patient safety with least of the resource utilization, WHO came on board with safety checklist in 2008.[3] The WHO 19-item checklist is based on advocating safety checks and a good communication among surgery team members during perioperative periods. It also contains a time-out procedure. In Pakistan, in spite of the great effectiveness, the time-out is either not practiced or is done by some junior, and not by the operating surgeon at the preoperative time. A time-out is a short interval before incision during which it is confirmed that the patient on the surgery bed is the correct one, the procedure to be performed on it is exact and at the required part of body either marked or unmarked.[4] The surgeon should be present at the time-out and all members should guarantee the correct patient, procedure and site. Patient participation in the time-out process is also advised. Majority of the patients show great compliance and satisfaction for participating in the time-out procedure. ---Continue

Implementation of the TALK© clinical self-debriefing tool in operating theatres: a single-centre interventional study

BackgroundDebriefing in operating theatre environments leads to benefits in mortality, efficiency, productivity, and safety culture; however, it is still not regularly performed. TALK© is a simple and widely applicable team self-debriefing method to collaboratively learn and improve. MethodsAn interventional study introducing TALK© for voluntary clinical debriefing was carried out in operating theatre environments in a UK National Health Service hospital over 18 months. It explored compliance with the Five Steps to Safer Surgery and changes in behaviour in surgical teams regarding consideration and completion of debriefing. ResultsTeam briefing and compliance with the WHO surgical safety checklist were performed consistently (>95% and >98%, respectively) throughout the study, which included 460 surgical lists. Consideration of debriefing increased at all data collection periods after intervention, from 35.6% to 60.3–97.4% (P≤0.003). Performance of debriefing, which was 23.3% at baseline, reached 39% at 6 months (P=0.039). Team planning of actions for improvement during debriefing also increased (P<0.001). A decline in performance of debriefing and subsequent improvement actions was observed after 6 months, albeit rates were above baseline at 18 months. The most reported reason not to carry out a debriefing was ‘lack of issues’. After implementation, nurses and allied healthcare professionals increased their contribution to initiating and leading debriefing. Reported barriers were <18% at baseline, and decreased after intervention. ConclusionsA simple intervention introducing TALK© for voluntary debriefing in theatres prompted significant changes in team behaviour and sustained growth regarding consideration and performance of debriefing, especially in the first 6 months.

Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol.

The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC. A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems. Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.

Role of the WHO Surgical Safety Checklist in Reducing Morbidity and Mortality Among Obstetrics and Gynecology Patients Undergoing Surgery: A Prospective Comparative Study.

As surgery is an essential aspect of healthcare around the globe, it is necessary to consider complications related to it. Therefore, this study was conducted to evaluate the impact of the World Health Organization Surgical Safety Checklist (WHO SSC) on reducing the incidence of postoperative complications Methods: This single-center, prospective, comparative study was conducted at the Department of Gynecology and Obstetrics in a government hospital in Patna, Bihar. To assess the efficacy of the WHO SSC, the patients were divided into two groups, in which one group undergoing surgery was assessed with the checklist, and the other group was not. The rates of surgery-related complications were then compared in both groups. Our results showed a reduction in surgery-related complications in patients assessed with the WHO SSC. No statistically significant difference in duration of surgery was found between the groups. However, a statistically significant difference was observed in the rates of surgery-related complications between groups, especially in sepsis (p=0.0009), hemorrhage (p<0.0001), and infection at the site of surgery (p<0.0001). Mortality rates were not affected by the use of the SSC. The WHO SSC is a simple yet effective tool for reducing postoperative complications by improving communication between the various team members working in the operation theatre, although it has no effect on reducing mortality. Further research is needed to enhance its successful implementation and ensure its sustained use.

Safety of surgery: quality assessment of meta-analyses on the WHO checklist.

To assess the quality of the meta-analyses that review the WHO surgical safety checklist. A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

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&amp;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&amp;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&amp;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.

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.

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.

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.

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.

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.

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.