Enhancing surgical safety checklist utilization at a rural primary hospital through a quality improvement project (QIP)

Abstract Background Despite evidence demonstrating various benefits of the World Health Organization (WHO) Surgical Safety Checklist (SSC), its utilization is less frequent in low- and middle-income countries (LMICs). This quality improvement project (QIP) was conducted at a rural primary hospital in Ethiopia to address suboptimal utilization of the SSC. At baseline, an average SSC utilization rate was 50% and a completion rate was 80% over the prior 6 months (October 2023–March 2024). Objective This study aimed to enhance the utilization and completion rates of the WHO SSC through a structured QIP. Methods A single-cycle Plan-Do-Study-Act approach was employed to enhance adherence. Key interventions included translating the SSC into Amharic, conducting a two-day training session, introducing pre- and postoperative briefings, and requiring surgeons to remain in the operation theater until checklist completion. Biweekly audits and supervision were conducted to monitor progress. Key performance indicators were SSC utilization and completion rates, while secondary indicators included the rate of prophylactic antibiotic administration and SSI. Trend analysis using run charts evaluated changes over time, while staff interviews provided insights into behavioral and attitudinal shifts. Results The QIP demonstrated a significant and sustained improvements. Baseline measurements in October 2023 showed a utilization rate of 50% and a completion rate of 80%. Following targeted interventions, both metrics steadily improved, reaching 100% by June 2024 and maintaining this level through September 2024. Conclusion The QIP demonstrated that achieving 100% utilization and completion of the WHO SSC is feasible even in rural hospitals of LMICs. Formal training proved crucial for improving adherence, addressing gaps seen with informal approaches. This underscores the value of structured, localized interventions for improving surgical safety practices and encourages broader adoption in similar contexts. To sustain the results, ongoing supportive training, monthly supervision, and staff recognition initiatives were initiated.