title: A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery.
abstract: OBJECTIVE
  A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.
  
  
  BACKGROUND
  With the aim of increasing patient safety, checklists have gained growing attention. Information about effectiveness, compliance, and critical factors for implementation is crucial for whether and which of the available instruments to use.
  
  
  METHODS
  Medline including Premedline (OvidSP), Embase, and Cochrane Collaboration Library, hand search, a search of reference lists of key articles, and tables of content.
  
  
  METHODS
  Electronic databases returned 4997 citations, of which 84 articles were chosen for full-text review. Finally, 22 articles were included in this review.
  
  
  METHODS
  Data relating to care setting, study methods and design, sample population, survey response rate, type of checklist, aim, effectiveness, compliance, attitudes, and critical factors were extracted from the studies. A random effects meta-analysis of effectiveness data was conducted if 2 or more studies reported a specified outcome.
  
  
  RESULTS
  With the use of checklists, the relative risk for mortality is 0.57 [95% confidence interval (CI): 0.42-0.76] and for any complications 0.63 (95% CI: 0.58-0.67). The overall compliance rate ranged from 12% to 100% (mean: 75%) and for the Time Out from 70% to 100% (mean: 91%).
  
  
  CONCLUSIONS
  Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed.
authors.affiliation: Swiss Patient Safety Foundation, Zurich, Switzerland.
authors.forename: Annegret
authors.initials: A
authors.lastname: Borchard
authors.forename: David L B
authors.initials: DL
authors.lastname: Schwappach
authors.forename: Aline
authors.initials: A
authors.lastname: Barbir
authors.forename: Paula
authors.initials: P
authors.lastname: Bezzola
mesh_terms: D057189:Checklist / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D061214:Patient Safety / Q000592:standards*