title: Compliance with the WHO Surgical Safety Checklist: deviations and possible improvements.
abstract: BACKGROUND
  Previous research suggests that the World Health Organization Surgical Safety Checklist time-out reduces communication failures and medical complications and supports development of better safety attitudes. Previous research also indicates that different values can affect the implementation of interventions.
  
  
  OBJECTIVE
  To investigate the actual usage of the checklist in practice and to catalogue deviations for the purpose of identifying improvements.
  
  
  METHODS
  Twenty-four surgical procedures were video recorded. The time-out was analysed quantitatively assessing compliance with a predefined observational protocol based on the checklist and qualitatively to describe reasons for non-compliance.
  
  
  METHODS
  The operating unit of a Swedish county hospital.
  
  
  METHODS
  Compliance with checklist items and the participation of different personnel groups. Activities were conducted during the time-out.
  
  
  RESULTS
  Highest compliance was associated with patient ID, type of procedure and antibiotics; the worst with site of incision, theatre nurse team reviews and imaging information. Team member introductions occurred in half of the operations. Surgeons and the anaesthesia team dominated the time-out.
  
  
  CONCLUSIONS
  The checklist is not always applied as intended. The components that facilitate communication are often neglected. The time-out does not appear to be conducted as a team effort. It is plausible that the personnel's conception of risk and the perceived importance of different checklist items are factors that influence checklist usage. To improve compliance and involve the whole team, the concept of risk and the perceived relevance of checklist items for all team members should be addressed.
authors: Department of Design Sciences, Lund University, SE-221 00 Lund, Sweden. christofer.rydenfalt@design.lth.se
authors: Christofer
authors: C
authors: Rydenfält
authors: Gerd
authors: G
authors: Johansson
authors: Per
authors: P
authors: Odenrick
authors: Kristina
authors: K
authors: Åkerman
authors: Per Anders
authors: PA
authors: Larsson
mesh_terms: D057189:Checklist; D003142:Communication; D003299:Cooperative Behavior; D019983:Guideline Adherence; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D019370:Observation; D009873:Operating Rooms; D061214:Patient Safety; D058996:Quality Improvement; D013548:Sweden; D014741:Video Recording; D014944:World Health Organization