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SCP: WHO Surgical Safety Checklist
Summary of evidence for effectiveness

In 2012 a systematic literature review by Borchard et al was published which assessed the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.

The review considered studies that investigated these aspects either for the WHO Surgical Safety Checklist, the SURPASS checklist, or the Universal Protocol or any adaptations or modifications of these checklists1.

A total of 22 articles met the inclusion criteria. Of these, 20 were quantitative and two were qualitative studies. Seventeen studies used either the Universal Protocol or the WHO checklist or a newly developed protocol on the basis of one or both of these two protocols. In four studies, the SURPASS checklist was used.

The below information focuses on the reported outcomes relating to the effectiveness of the checklists. The review’s results on critical factors for a successful implementation are summarized in the section “Short description of the SCP and information on implementation”.

Thirteen articles were identified that described the effectiveness of checklists or protocols. Of these, five studies reported data about mortality, four specified data about any complications, and all but one described one or more “other specified outcome”. Meta-analysis of the effectiveness data was conducted on three prospective prepost observational studies which shared the reporting of specific outcomes. The two larger studies included here are the international multicenter test study for the WHO checklist (Haynes et al 2009) as well as a Dutch multicenter study investigating the effectiveness of the SURPASS checklist (de Vries et al 2010). The third study included in the meta-analysis examined the use of the WHO Surgical Safety Checklist in trauma and orthopaedic patients in England (Sewell et al 2009).

Meta-analysis revealed that across the three prospective prepost observational studies the relative risk for mortality with the use of the checklist is 0.57 [95% confidence interval: 0.42-0.76] and for any complications 0.63 [95% confidence interval: 0.58-0.67]. Further, in these three prospective studies, the surgical site infection rate was determined and the relative risk for this outcome calculated as 0.62 [95% confidence interval: 0.58-0.67]. Two of these prospective observational studies showed that with the use of the WHO or SURPASS checklist the relative risk for unplanned return to the operating room using the checklist is 0.76 [95% confidence interval: 0.56-1.02].

The authors conclude that the implementation of a checklist in surgery is an effective tool for decreasing the burden of morbidity and mortality in hospitals.

 


1 The SURPASS (SURgical PAtient Safety System) checklist is supposed to prevent adverse events along the whole surgical pathway from admission to discharge, whereas the Universal Protocol focuses on preventing wrong site surgery and includes preprocedure verification, site marking and a Time Out. The Universal Protocol is not a checklist but recommends the use of a checklist for implementation.

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