Publication Date

12-1-2021

Document Type

Article

Department

Psychology

Disciplines

Patient Safety | Surgery

Publication Title

Journal of the American College of Surgeons

Volume

233

Issue

6

DOI

10.1016/j.jamcollsurg.2021.08.692

First Page

794

Last Page

809.e8

Abstract

Background
The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use.
Study Design
We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Results
Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes—Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture—pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes—Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices—are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC.
Conclusions
The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.

Funding Number

400393

Funding Sponsor

Canadian Institutes of Health Research

Comments

This is the Version of Record and can also be read online here.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Share

COinS