Quality Improvement (QI) Project: Enhancing Surgical Safety Checklist Utilization at a Rural Primary Hospital
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Background
Despite evidence demonstrating various benefits of the World Health Organization (WHO) Surgical Safety Checklist (SSC), its utilization is less frequent in low and middle income countries. This quality improvement project was conducted at a Primary Hospital, a rural facility in Ethiopia, to address suboptimal utilization of the SSC. At baseline, an average SSC utilization rate was 50% and a completion rate was 80% over the prior 6 months.
Methods
A single cycle Plan-Do-Study-Act (PDSA) approach was employed to enhance adherence. Key interventions included translating the SSC into Amharic, conducting a two-day training session, introducing pre- and post-operative briefings, and requiring surgeons to remain in the operating room until checklist completion. Bi-weekly audits and regular supervision were conducted to monitor progress. Key performance indicators were SSC utilization and completion rates, while secondary indicators included rate of prophylactic antibiotic administration and surgical site infection. Trend analysis using run charts and Interrupted Time Series (ITS) analysis evaluated changes over time, while staff interviews provided insights into behavioral and attitudinal shifts.
Results
The quality improvement project demonstrated a significant and sustained improvement in the utilization and completion rates of the WHO Surgical Safety Checklist (SSC). Baseline measurements in October 2023 showed a utilization rate of 53% and a completion rate of 65%. Following targeted interventions, both metrics steadily improved, reaching 100% by June 2024 and maintaining this level through September 2024.
Conclusion
The QI project demonstrated that achieving 100% utilization and completion of the WHO Surgical Safety Checklist (SSC) is feasible even in rural hospitals of low- and middle-income countries (LMICs). Formal training proved crucial for improving adherence, addressing gaps seen with informal approaches, and fostering better team communication and culture. This underscores the value of structured, localized interventions for improving surgical safety practices and encourages broader adoption in similar contexts. To sustain the results, ongoing supportive trainings, monthly supervision, and staff recognition initiatives were initiated.
