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Surgical provider perspectives in implementing the World Health Organization's surgical safety checklist in a low-and middle-income country

Abstract:

Background: The World Health Organization’s Surgical Safety Checklist (WHO-SSC) has been shown to be effective in reducing complication and mortality rates associated with surgery in both highand low-income settings; however, recent evidence from a study of 101 hospitals in Ontario, Canada did not show any association between WHO-SSC use and reductions in these measures. Authors’ discussion and subsequent commentaries suggest that the lack of meaningful improvements in surgical safety might reflect inadequate adherence to the WHO-SSC in these hospitals. Data on the implementation and use of the WHO-SSC is limited in Latin America. The public Hospital Regional Vicente Corral Moscoso (HVCM) and private Hospital Universitario del Rio (HUR) in Cuenca, Ecuador began using the WHO-SSC in September 2013 and April 2014, respectively, providing an opportunity to study the use of the recently implemented checklist. Methods: A descriptive, cross-sectional study was performed at these two hospitals in Cuenca, Ecuador using:(1) operating room observations and informal discussions with staff by an educational observer in order to determine adherence rates to the pre-incision and post-operative phases of the WHO-SSC and (2) questionnaires administered to surgical staff at each hospital in order to gather the perspectives of nurses, surgeons, and anesthesiologists on WHO-SSC effectiveness and use, as well as overall patient safety management in each hospital. Findings: 30 operations were observed (n= 16 public, n= 14 private). Incorrect use and incompleteness were present in both hospitals. Overall adherence was …