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. 2024 Jan 30;58(3):278-288.
doi: 10.1007/s43465-024-01096-5. eCollection 2024 Mar.

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

Karthick Rangasamy  1 , Madhan Jeyaraman  2 , Preethi Selvaraj  3 , Nirmal Raj Gopinathan  1 , Divyalakshmi Arumugam  4 , Mandeep Singh Dhillon  1
Affiliations

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

Karthick Rangasamy et al. Indian J Orthop. .

Abstract

Background: 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.

Materials and methods: 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.

Results: 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 (< 20 years of experience) than among those with > 20 years 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.

Conclusion: 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.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01096-5.

Keywords: Orthopaedic surgery; Sign-in; Surgical safety checklist; Tourniquet; WHO.

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Conflict of interest statement

Conflict of InterestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram showing methodology and data collection process
Fig. 2
Fig. 2
Distribution of surgeon—seniority levels
Fig. 3
Fig. 3
Suggested modifications in “Sign-in” section of 2009 WHO SSC for orthopaedic surgeries
Fig. 4
Fig. 4
Suggested modifications in “Time-out” section of 2009 WHO SSC for orthopaedic surgeries
Fig. 5
Fig. 5
Suggested modifications in “Sign-out” section of 2009 WHO SSC for orthopaedic surgeries
Fig. 6
Fig. 6
Radar plot showing overall suggested modifications of 2009 WHO SSC for orthopaedic surgeries
See this image and copyright information in PMC

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References

    1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. The New England Journal of Medicine. 2009;360(5):491–499. doi: 10.1056/NEJMsa0810119. - DOI - PubMed
    1. van Schoten SM, Kop V, de Blok C, Spreeuwenberg P, Groenewegen PP, Wagner C. Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: Results of a national patient safety programme in the Netherlands. British Medical Journal Open. 2014;4(7):e005075. doi: 10.1136/bmjopen-2014-005075. - DOI - PMC - PubMed
    1. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. (2009). Geneva: World Health Organization. - PubMed
    1. Noordin S, McEwen JA, Kragh JF, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. The Journal of Bone and Joint Surgery American Volume. 2009;91(12):2958–2967. doi: 10.2106/JBJS.I.00634. - DOI - PubMed
    1. Lyons VE, Popejoy LL. Meta-analysis of surgical safety checklist effects on teamwork, communication, morbidity, mortality, and safety. Western Journal of Nursing Research. 2014;36(2):245–261. doi: 10.1177/0193945913505782. - DOI - PubMed

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