Enhanced Surgical Safety Checklist Implementation Improves Safety Culture Among Surgical and Anesthesiology Residents: A Prospective Study in a Resource-Limited Tertiary Hospital

Background : The Surgical Safety Checklist (SSC) improves patient safety, but its impact on residents’ perceptions of safety culture in resource-limited settings remains underexplored. Objective : To evaluate an enhanced SSC implementation strategy, incorporating structured feedback and interdisciplinary mentorship, on safety culture perceptions among surgical and anesthesiology-intensive care residents (AIC) in a Romanian tertiary hospital. Methods : A 6-month prospective cohort study (July–December 2024) was conducted at the Emergency Clinical Hospital of Constanta, Romania, enrolling 45 participants, including 25 general surgery residents and 20 AIC residents. The intervention included SSC training, postoperative 3-item feedback forms, and biweekly mentorship sessions. Pre- and post-intervention Safety Attitudes Questionnaire (SAQ) scores were compared using Wilcoxon signed-rank tests; logistic regression identified predictors of improvement in perception. Results : Of 45 residents, 42 (93%) completed the study. Teamwork climate scores increased from 67.8±11.9 to 82.9±9.5 (p<0.001) and safety climate from 69.5±12.1 to 81.7±10.3 (p<0.01). SSC compliance reached 90%. Feedback frequency was a key predictor of perception improvement (OR 2.4, 95% CI: 1.5–3.8). Limitations include the single-center design and lack of a control group or clinical outcome data. Conclusion : An enhanced SSC strategy was associated with a significant improvement in residents’ perceptions of safety culture, offering a scalable model for resource-limited settings. Multicenter studies with control groups and clinical outcomes are needed to confirm generalizability and practical impact. The study was retrospectively registered with the ISRCTN registry (ISRCTN88241350) in accordance with WHO trial registration standards.