ISQUA18-2517Surgical Team Cooperation and Compliance with WHO Surgical Safety Checklist in a Tertiary Hospital, Vietnam

Abstract

Objectives: Little has been known about compliance with WHO Surgical Safety Checklist (SSC) in developing world. The study aimed to assess the cooperation between surgical team members and compliance with SSC in a tertiary maternity hospital in Vietnam. Method(s): The 2009 WHO SSC was introduced and used at Hung Vuong hospital, a tertiary 900-bed maternity hospital in Vietnam, from 2014. A cross-sectional study was conducted from February 1st to May 31st, 2017 to evaluate the actual practice of using 2009 WHO SSC. Four trained assessors independently examined each case separately throughout the study duration. SSC was implemented if the operating team completed the checklist on paper. The practice of verbal communication to complete the checklist was used to assess the compliance of surgical team in each of the three phases of the checklist (Sign In, Time Out and Sign Out). Compliance with SSC was operationally defined as all members of operating team read out loud and responded accordingly all the questions listed in the WHO SSC. The level of cooperation was then assessed by the assessor for each team member separately and was classified as (i) good if the person expressed eagerness and was focused in completing the checklist; (ii) average if the person was focused in completing the checklist); and (iii) poor if the person did their personal work while completing the checklist or expressed uninterested. Individual cooperation level was then used to plan for group-based SSC adherent improvement intervention. Data was collected, stored and analyzed using Microsoft Excel 2010. The internal review board approved the proposal for this study. Result(s): The overall SSC implementation rate was 100% (216/216) but the overall compliance rate was only 44.4% (96/216). The compliance rate of Sign In, Time Out and the Sign Out period were 70.8% (153/216), 72.2% (156/216) and 54.6% (118/216), respectively. Compliance in senior surgeons was also as twice as that of the junior ones (60% versus 36%). Checklists were completed with the presence of anesthesiologist in 76.9% (166/216) and midwife in 73.3% (140/ 216) of all cases. Among 191 obstetric surgeries, midwives participated in completing Time Out phase in 92% cases. Comparing levels of cooperation between each surgical team member's role, only 8-14% cases were at "average" level and 0.5% were at "poor" level. There were 8 cases (3.7%) had surgical instrument incident reported. Image: Conclusion(s): Despite of high implementation of 2009 WHO SSC rate, the overall compliance was low. The study highlighted further efforts to improve SSC compliance in developing countries.