Compliance With the World Health Organization Surgical Safety Checklist in the Operating Room at the National Referral Hospital, Bhutan: A Cross-Sectional Quality Assessment

OBJECTIVES: This quality assessment was conducted to determine the compliance rate of the modified WHO Surgical Safety Checklist at the National Referral Hospital, Bhutan. METHODS: A cross-sectional study was conducted as a quality improvement assessment in the Operating Room (OR) at the National Referral Hospital, Bhutan. All the elective surgical procedures performed under general and/or spinal anesthesia were included. Compliance with the Sign In, Time Out and Sign Out domains was assessed. RESULTS: In the Sign In domain, patient identity was confirmed in 76.4% of cases, and the anesthesia safety checklist was appropriately completed in 75.2% of procedures. In the Time Out domain, the status of preoperative antibiotic prophylaxis was verbally confirmed in only half of the cases. In the Sign Out domain, correct counting of instruments and gauze and complete specimen labeling were ensured in merely one-fourth of the procedures (24.8%). The composite compliance rates for the surgical safety checklist domains were 46.4% for Sign In, 24.8% for Time Out, and 5.2% for Sign Out. Compliance varied significantly across checklist domains and surgical specialties. Compliance also declined significantly as checklist administration progressed, from 76.4% for the first item to 6.4% for the final item (r=-0.93, P<0.001). This decline in the Sign Out domain was consistent across surgical specialties (χ2=8.26, df=5, P=0.142). CONCLUSION: The surgical safety checklist is underutilized, with overall compliance being low, particularly in the Sign Out domain, underscoring the need for targeted interventions to improve adherence.