Compliance and surgical team perceptions of WHO Surgical Safety Checklist: systematic review

Wangoo, Laltaksh, Ray, Robin A., and Ho, Yik-Hong (2016) Compliance and surgical team perceptions of WHO Surgical Safety Checklist: systematic review. International Surgery, 101 (1-2). pp. 35-49.

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This systematic review aimed to assess surgical safety checklist compliance and evaluate surgical team perceptions and attitudes, post-checklist implementation in the operating room. The World Health Organization (WHO) surgical safety checklist (SSC) has decreased complications and mortality. However, it is unclear whether this reduction is influenced by the vicarious enhancement in teamwork, communication, and staff awareness established by SSC implementation. The preferred reporting items for systematic reviews and meta-analyses model of review guided a search across MEDLINE, PubMed, and Embase databases. English-language studies using any adapted form of the WHO-SSC in operating rooms were reviewed by abstract and full text. Twenty-six studies, 13 assessing SSC compliance and 13 investigating surgical team perceptions of SSC, were evaluated. Compliance studies showed a checklist initiation rate of >90%, but actual observed completion rate varied widely across studies. Sign out was the most poorly performed phase of the checklist (<50%) with time out being the best. Verification of patient identity and procedure demonstrated a high degree (>90%) of compliance across studies, but "verification of team-members'' was significantly less compliant. Studies assessing surgical team perceptions found that SSC improved participants' perception of teamwork, communication, patient safety, and staff awareness of adverse events. However, when stakeholders placed differing degrees of importance on SSC completion, results indicated the SSC might actually antagonize team relationships. SSC compliance varies significantly across studies, being highly dependent on staff perceptions, training, and effective leadership. Surgical teams have positive perceptions of SSC; thus with effective implementation strategies, compliance rates across all phases can be substantially improved.

Item ID: 49427
Item Type: Article (Research - C1)
ISSN: 0020-8868
Keywords: WHO surgical safety checklist, surgical team perceptions, compliance rates,adherence rates, operating room staff survey, patient safety
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© 2016 Wangoo et al.; licensee The International College of Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non-commercial and is otherwise in compliance with the license. See:

Date Deposited: 21 Jun 2017 07:30
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320226 Surgery @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 100%
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