Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 12:13:14.
doi: 10.1186/s13037-019-0194-4. eCollection 2019.

Adherence to the WHO surgical safety checklist: an observational study in a Swiss academic center

René Schwendimann  1   2 , Catherine Blatter  2 , Marc Lüthy  3 , Giulia Mohr  1 , Thierry Girard  3 , Siegfried Batzer  3 , Erica Davis  1 , Henry Hoffmann  4
Affiliations

Adherence to the WHO surgical safety checklist: an observational study in a Swiss academic center

René Schwendimann et al. Patient Saf Surg. .

Abstract

Background: The World Health Organization (WHO) Surgical Safety Checklist is used globally to ensure patient safety during surgery. Two years after its implementation in the University Hospital Basel's operating rooms, adherence to the protocol was evaluated.

Methods: This mixed method observational study took place in the surgical department of the University Hospital of Basel, Switzerland from April to August 2017. Data collection was via individual structured interviews with selected OR team members regarding checklist adherence and on-site non-participant observations of Team Time Out and Team Sign Out sequences in the OR. Data were subjected to thematic analysis and descriptive statistics compiled.

Results: Comprehensive local expert interviews indicated that individual, procedural and contextual variables influenced the application of the checklist. Facilitating factors included well-informed specialists who advocated the use of the Checklist, as well as teams focused on the checklist's intended process and on its content. In contrast, factors such as staff insecurity, a generally negative attitude towards the checklist, a lack of teamwork, and hesitance to complete the checklist, hindered its implementation.The checklist's application was evaluated in 104 on-site observations comprising of 72 Team Time Out (TTO) and 32 Team Sign Out (TSO) sections. Adherence to the protocol ranged between 96 and 100% in TTO and 22% in TSO respectively. Lack of implementation of the TSO was mainly due to the absence of one of the key OR team members, who were busy with other tasks or no longer present in the operating room.

Conclusion: The study illustrates factors, which foster and hinder consistent application of the WHO surgical safety checklist namely individual, procedural and contextual. It also demonstrates that the TTO was consistently and correctly applied, while the unavailability of key OR team members at sign-out time was the most common reason for omission or incomplete use of the TSO.

Keywords: Adherence; Short report; Surgical checklist; Team sign out; Team time out.

PubMed Disclaimer

Conflict of interest statement

Waived by the regional Ethics committee (EKNZ, REQ–2017–00372).Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Excerpts from the original observer reports regarding TTO and TSO checklist items
See this image and copyright information in PMC

References

    1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–499. doi: 10.1056/NEJMsa0810119. - DOI - PubMed
    1. Bergs J, Hellings J, Cleemput I, Zurel O, De Troyer V, Van Hiel M, Demeere JL, Claeys D, Vandijck D. Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. Br J Surg. 2014;101(3):150–158. doi: 10.1002/bjs.9381. - DOI - PubMed
    1. Sendlhofer G, Mosbacher N, Karina L, Kober B, Jantscher L, Berghold A, Pregartner G, Brunner G, Kamolz LP. Implementation of a surgical safety checklist: interventions to optimize the process and hints to increase compliance. PLoS One. 2015;10(2):e0116926. doi: 10.1371/journal.pone.0116926. - DOI - PMC - PubMed
    1. Treadwell JR, Lucas S, Tsou AY. Surgical checklists: a systematic review of impacts and implementation. BMJ Qual Saf. 2014;23(4):299–318. doi: 10.1136/bmjqs-2012-001797. - DOI - PMC - PubMed
    1. Verwey S, Gopalan PD. An investigation of barriers to the use of the World Health Organization surgical safety checklist in theatres. S Afr Med J. 2018;108(4):336–341. doi: 10.7196/SAMJ.2018.v108i4.12780. - DOI - PubMed