Incorporating the World Health Organization Surgical Safety Checklist into practice at two hospitals in Liberia.

Background: The impact of the World Health Organization's Patient Safety Programme's 19-item Surgical Safety Checklist on surgical processes and outcomes was assessed in 2008-2009 at two hospitals in the resource-limited setting of Liberia.

Methods: In the preintervention phase, data were prospectively collected on surgical processes and outcomes from 232 consecutively enrolled patients who were undergoing surgery. In the postintervention phase, data were collected on 249 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. Multivariable logistic regression was used to determine the adjusted association between the introduction of the checklist and surgical process and outcome measures. These analyses were conducted among the pooled data, as well as for data stratified by hospital.

Results: The introduction of the checklist was associated with significant (p < 0.05) improvements in terms of overall surgical processes and surgical outcomes. The stratified analysis presented a more nuanced result by hospital. In Hospital 1, the checklist was significantly associated with improved adherence to the composite measure of surgical processes but was not associated with improved surgical outcomes. In contrast, in Hospital 2, it was significantly associated with improved surgical outcomes but was not associated with improved adherence to the composite measure of surgical processes.

Conclusions: Although the implementation of a surgical safety checklist in Liberia was associated with significant improvements in processes and outcomes overall, differences at the hospital level suggest that the checklist's mechanism of improvement may be influenced by the availability of resources needed to complete recommended processes, variation in team functioning, and organizational context.