• Maia R Nofal, Nichole Starr, Negussie MammoTihitenaTLifebox Foundation, Addis Ababa, Ethiopia.Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia., Amber W Trickey, Natnael Gebeyehu, Luca Koritsanszky, Mechale Alemu, Mansi Tara, Senait Bitew Alemu, Faye Evans, Selam Kahsay, and Thomas G Weiser.
• Department of Surgery, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
• Br J Surg. 2023 Oct 10; 110 (11): 151115171511-1517.

BackgroundThe WHO Surgical Safety Checklist reduces morbidity and mortality after surgery, but uptake remains challenging. In particular, low-income countries have been found to have lower rates of checklist use compared with high-income countries. The aim of this study was to determine the impact of educational workshops on Surgical Safety Checklist use implemented as part of a quality improvement initiative in five hospitals in Ethiopia that had variable experience with the Surgical Safety Checklist.MethodsFrom April 2019 to September 2020, each hospital implemented a 6-month surgical quality improvement programme, which included a Surgical Safety Checklist workshop. Statistical process control methodology was used to understand the variation in Surgical Safety Checklist compliance before and after workshops and a time-series analysis was performed using population-averaged generalized estimating equation Poisson regression. Checklist compliance was defined as correctly completing a sign in, timeout, and sign out. Incidence rate ratios of correct checklist use pre- and post-intervention were calculated and the change in mean weekly compliance was predicted.ResultsChecklist compliance data were obtained from 2767 operations (1940 (70 per cent) pre-intervention and 827 (30 per cent) post-intervention). Mean weekly checklist compliance improved from 27.3 to 41.2 per cent (mean difference 13.9 per cent, P = 0.001; incidence rate ratio 1.51, P = 0.001). Hospitals with higher checklist compliance at baseline had the greatest overall improvements in compliance, more than 50 per cent over pre-intervention, while low-performing hospitals showed no improvement.ConclusionSurgical Safety Checklist workshops improved checklist compliance in hospitals with some experience with its use. Workshops had little effect in hospitals unfamiliar with the Surgical Safety Checklist, emphasizing the importance of multifactorial interventions and culture-change approaches. In receptive facilities, short workshops can accelerate behaviour change.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

18 keywords...

hide…