Factors that enhance compliance with the Surgical Safety Checklist
The World Health Organization (WHO) has reported that its Surgical Safety Checklist (SSC) has resulted in significant reductions in morbidity and mortality. Despite its proven success, meaningful compliance with the Surgical Safety Checklist initiative has been low.
The authors sought to identify and explore published research on factors that enhance compliance with the SSC within surgical team members.
A review of the literature published between January 2017 and January 2021 was undertaken. Six databases were searched, and 1340 studies were screened for eligibility. The 17 studies included were critically appraised using the Crowe Critical Appraisal Tool.
Three main themes were identified: training and innovations; process adaptations and team leadership.
This review of the literature draws attention to the complexities of checklist compliance and identifies the need for training, leadership and adaptation to new safety processes.
Annually, more than 300 million surgical procedures are performed worldwide (Weiser et al, 2016). Although the majority have the desired patient outcome with no adverse events, errors still occur. Surgery is associated with two thirds of in-hospital adverse events (de Vries et al, 2010). The Surgical Safety Checklist (SSC) was introduced by the World Health Organization (WHO) (2009) to address patient safety, ineffective communication and eliminate memory-dependent errors. Figure 1 outlines the key components of the SSC (WHO, 2009). The checklist, which has undergone minor revisions by the WHO, and has been adapted for use in England and Wales and is widely used in Ireland, is divided into three sections:
Checklists assist with the delivery of skilled care and can been seen as one of the greatest technical advances in surgical safety this century (Gillespie et al, 2018). Both early research and follow-up studies reported a reduction in mortality when the checklist was used effectively (Bergs et al, 2014; GlobalSurg Collaborative, 2016). The SSC has received worldwide acclaim and is currently used in 132 countries (Gillespie et al, 2018; NHS England, 2019). Safety checklists improve surgical safety through fostering better inter-professional teamwork and communication (Russ et al, 2013).
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