Evaluation of compliance and utilization of the World Health Organization surgical safety checklist at the Lagos University Teaching Hospital: A cross-sectional study

ABSTRACT Background: The WHO surgical safety checklist (SSC) was introduced in 2008 to ensure consistency in patient safety in surgery worldwide. To be effective, it must be properly utilized. This study was conducted to evaluate the compliance and utilization of the WHO SSC at the Lagos University Teaching Hospital (LUTH). Methods: This mixed-method study was conducted over 12 weeks from November 29, 2023, to February 14, 2024. A prospective review of the hospital records of all patients who had surgical procedures was performed to assess the utilization and completeness of the SSC. Direct observation of the use of the SSC assessed the quality of delivery and attention of team members. After data collection, a survey was administered to 100 perioperative staff to determine previous training on the SSC, perception of its usefulness, and barriers to its implementation. Results: Three hundred and twenty surgical procedures were studied, of which 134 had direct observation of checklist implementation. There was 96.9% utilization (310 procedures) of the SSC during the surgeries. Sign-in was done in all but incomplete in 36.6%. Sign-in was similarly performed during emergency cases (98.3%) and elective cases (96.0%), P = 0.253 and during general anesthesia (96.8%), regional anesthesia (97.9%), and monitored anesthesia care (95.2%), P = 0.834. Most surgical specialties recorded 100% sign in except ophthalmology (27.3%). More use of the SSC was noted with the first cases of the day. Time out was done in 89.7% of procedures and completed in all. It was performed significantly more often during emergency cases 95.0% than elective cases 86.6% ( P = 0.017). However, general 90.8%, regional anaesthesia 87.5%, and monitored anesthesia care 81.0% were comparable ( P = 0.310). Of the 134 observed cases, quality of delivery was good in 72.7% but complete attention was noted in only 48.3%. Sign-out was omitted in all cases (100%). Seventy-four perioperative staff completed the survey, and 62.5% had no formal training on the use of SSC. Ninety-six (96%) agreed that the checklist improves communication and organization in the operating room and the culture of patient safety in the hospital. The main limitation to the use of SSC was stated to be workforce shortage. Conclusion: There are inadequacies in employing the SSC in LUTH. Completeness and quality of delivery required improvement. The importance of sign-out needs to be emphasized. Regular training and retraining of the perioperative staff are necessary to succeed.