The World Health Organisation's Surgical Safety Checklist in Belgian Operating Theatres : a Content-Driven Evaluation

Abstract

Rationale, aims and objectives : It is unclear which items of the WHO surgical safety checklist are most crucial for producing its associated benefits. Thoughtless modification, especially removing items, can therefore potentially lead to reduced effectiveness of the instrument. This study describes the modifications made by Belgian hospitals. Method : An online survey was used to find out which checklists are used. An expert panel conducted a content-driven evaluation of the retrieved checklists by verifying the presence of the WHO items and evaluating any modifications made. Results : All hospitals participating in the survey (n = 36) reported the use of a surgical safety checklist. Based on selfreport, 69.4% (n = 25) of hospitals reported to use all WHO items. The expert panel determined that 17.1% (n = 6) of checklists included all WHO items. Inclusion ranged from 7 to 22 items (mean = 16.6, Std. Dev. = 4.48). Detailing on the functional parts of the checklist, 48.6% (n = 17) of checklists contained all sign-in items, 25.7% (n = 9) contained all time-out items and 37.1% (n = 13) enclosed all sign-out items. Sixty percent (n = 21) of checklists added items not mentioned in the original WHO checklist. Conclusion : The modifications made to the WHO checklist vary between hospitals. Only a small number of hospitals included all 22 WHO items. It is unknown whether these modified checklists will be equally effective in decreasing the number of postoperative complications, including mortality. More detailed recommendations and guidance regarding the modification of the WHO surgical checklist is required.