title: Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project.
abstract: The World Health Organization (WHO) Surgical Safety Checklist is a cost-effective tool that has been shown to improve patient safety. We explored the applicability and effectiveness of quality improvement methodology to implement the WHO checklist and surgical counts at Mbarara Regional Referral Hospital in Uganda between October 2012 and September 2013. Compliance rates were evaluated prospectively and monthly structured feedback sessions were held. Checklist and surgical count compliance rates increased from a baseline median (IQR [range]) of 29.5% (0-63.5 [0-67.0]) to 85.0% (82.8-87.5 [79.0-93.0]) and from 25.5% (0-52.5 [0-60.0]) to 83.0% (80.8-85.5 [69.0-89.0]), respectively. The mean all-or-none completion rate of the checklist was 69.3% (SD 7.7, 95% CI [64.8-73.9]). Use of the checklist was associated with performance of surgical counts (p value < 0.001; r(2) = 0.91). Pareto analysis showed that understaffing, malfunctioning and lack of equipment were the main challenges. A carefully designed quality improvement project, including stepwise incremental change and standardisation of practice, can be an effective way of improving clinical practice in low-income settings.
authors.affiliation: Department of Anesthesia, Stanford University Medical Center, Stanford, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Lilaonitkul
authors.affiliation: Department of Anaesthesia and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Kwikiriza
authors.affiliation: Department of Anaesthesia and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: S
authors.initials: S
authors.lastname: Ttendo
authors.affiliation: Department of Anaesthesia and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Kiwanuka
authors.affiliation: Department of Anaesthesia and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: E
authors.initials: E
authors.lastname: Munyarungero
authors.affiliation: Great Ormond Street Hospital, NHS Foundation Trust, London, UK.|University College London Institute of Child Health, London, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: Walker
authors.affiliation: Department of Anaesthesia and Critical Care, Royal Alexandra Hospital, Paisley, UK.|University of the West of Scotland, Institute of Healthcare Policy and Practice, Paisley, UK.
authors.forename: K D
authors.initials: KD
authors.lastname: Rooney
mesh_terms: D057189:Checklist; D006801:Humans; D058996:Quality Improvement; D012017:Referral and Consultation; D013525:Surgical Instruments; D013514:Surgical Procedures, Operative / Q000592:standards*; D014454:Uganda; D014944:World Health Organization