The World Health Organization's 'Surgical Safety Checklist': Should Evidence-based Initiatives Be Enforced in Hospital Policy?

Objectives: To assess the awareness and voluntary usage of the World Health Organization's Surgical Safety Checklist (WHO SSC), just prior to its mandatory implementation.

Design: Questionnaire-based, prospective, telephone survey.

Setting: Patients are exposed to systematic risks and principles of surgical safety are inconsistently applied even in sophisticated settings. The evidence-based WHO SSC addresses shortfalls to promote patient safety. It was formally introduced in the United Kingdom in January 2009 and became a mandatory preoperative requirement in all hospitals from February 2010.

Participants: Two hundred and thirty-eight hospitals, both private and government-run, in the UK.

Main Outcome Measures: Appreciation among senior theatre personnel as to the existence, implementation and usage of the WHO SSC concept.

Results: Almost all had heard of the SSC, but in only two-thirds of hospitals was its use mandatory. Where the SSC was not compulsory, 80% were using it informally or sporadically. One-quarter of senior theatre personnel in hospitals without compulsory use indicated they did not know or that their department did not plan on using the checklist in the next six months, despite the deadline for implementation.

Conclusions: If the SSC is to optimize safety, then greater education and awareness is required.