///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-06:00

Implementation of WHO Safe Surgical Checklist in a West African Teaching Hospital

Abstract Number: F-53
Abstract Type: Original Research

Margaret Casey MD1 ; Vernon Ross MD2; Anca Matei MD3; Ron George MD, FRCPC4; Heather Scott MD, FRCSC5; Harry Tanto AT6

Introduction: To improve surgical morbidity and mortality globally, the World Health Organization (WHO) created the Surgical Safety Checklist (SSCL). This tool has decreased rates of surgical complications and death. It has been shown to enhance patient safety in the operating room. (1) In 2015, the Cape Coast Teaching Hospital (CCTH) in Cape Coast, Ghana completed the transition from community to teaching hospital. With this transition, an increase in the number and acuity of presenting cases was noted. In conjunction with a visiting team from Kybele, a non-profit humanitarian group, a strategy identified to improve morbidity and mortality after arrival at CCTH was the implementation of the SSCL. Based on the WHO template, the CCTH team created a SSCL specifically tailored to their institution. This project is an ongoing partnership between Kybele and CCTH.


Methods: This Quality Improvement (QI) project was designed to implement and assess the SSCL process at CCTH. REB was not sought as this is strictly QI. (2) In keeping with the guide from the WHO, implementation was initiated with didactic sessions and demonstrations in the operating rooms by Kybele members. Data was gathered at the time of implementation via staff opinion surveys. Twenty two surveys were distributed with a 100% return rate. Six months following implementation, Kybele members reviewed the implementation of the SSCL. The survey was recirculated and a random chart audit was also completed to identify both presence and completion of the document for each surgical patient. There were 29 post surveys returned, providing opinions from a variety of staff. Use of the SSCL was systematically observed in operating theatres during scheduled elective cases. Information collected was synthesized to allow for revision of the SSCL to accommodate the nuances of local practice.


Results: Data collected via 5-point Likert scale demonstrated an improvement in staff opinions of the SSCL including; endorsement of its role in improving communication and improving patient care. In additional comments, it was noted that time constraints (30%) and surgeon resistance (59%) were significant barriers to the use of the SSCL. Common themes included the identification of SSCL as a patient safety marker, as well as perceived improvement in nursing empowerment in the operating theatre.


Conclusion: Implementation of the SSCL at CCTH is a testament to the universality of the WHO initiative and confirmation of the described implementation plan. Initially part of a plan to reduce maternal and newborn mortality, in the hands of local leaders, the SSCL has been disseminated throughout CCTH and has become a standard of care. 

(1) Haynes AB et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med 2009: 360:4910499

(2) Government of Canada, Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans Article 2.5 2014

SOAP 2017