A prospective observational assessment of Surgical Safety Checklist use in Brasov Children's Hospital, barriers to implementation and methods to improve compliance.

Introduction: The WHO surgical checklist is a universal tool which has been shown to reduce surgical morbidity and mortality and improve patient safety; however, simply implementing a checklist in a hospital may not lead to its utilisation. We aim to evaluate completion of this checklist, and to investigate problems in compliance and methods for improving these.

Methods: In July 2015 data was recorded regarding compliance with each of the components of the Surgical Safety Checklist (SSC) in a Children's Hospital in Brasov. 40 surgeries were observed over 10 days, information was gathered as regards to the surgical speciality, the number of surgeries per day, the number of theatre staff present and whether it was elective or emergency. At the end of the 10 days questionnaires were given to 15 staff members to ask their opinions regarding the surgical checklist. Data analysis was performed using a chi-squared with p < 0.05 determining statistical significance.

Results: None of the checklists in the patient files were filled in; however, components of the SSC were completed, with an average of 55% of the checklist being performed. The percentage of the SSC completed was not statistically significant with different numbers of staff, theatre numbers of the day, speciality and whether it was elective or emergency.

Conclusion: The success of the Surgical Safety Checklist implementation is dependent on the training of staff to improve knowledge and compliance. It cannot be assumed that the introduction of a checklist will automatically lead to improved outcomes and communication with staff is essential in order to improve and ensure compliance.