WHO Surgical Checklist in Transplant Surgery: Still another tick box exercise? Results from a Closed Loop Audit at a Medium-Sized Transplant Centre

Background: There is compelling evidence that effective teamwork can significantly reduce adverse events in medical settings. Our 2014 audit revealed that the adherence to the WHO Surgical Checklist for renal transplant and vascular access procedures was less than optimal. Objective: The aim of this re-audit was to quantitatively evaluate any changes in practice since the 2014 findings and recommendations. Methods: Theatre personnel, comprising surgeons, nurses, and anaesthetists, were spontaneously queried regarding patient and staff details both intra-operatively and post-operatively, as outlined in the WHO Checklist. This was done across 54 surgical sessions with the Transplant Team. Importantly, staff were unaware of this impromptu survey, mitigating the potential for the Hawthorne effect. Results: The Checklist was rigorously adhered to in 100% of the operations (N=54) across all specified phases (Pre-anaesthesia induction - "Check-in"; Pre-skin incision - "Time out"; Prior to patient exiting the theatre - "Sign out"). These results were benchmarked against the 2014 study. While there was a statistically significant improvement in the recall of the patient's ID and the primary surgeon's name, the name of the assisting surgeon was not remembered in 78% of the queries. Moreover, full retention of the anaesthetist's and scrub nurse's IDs was not achieved. Notably, no intraoperative "never events" or near-miss incidents were recorded in either cohort. Conclusions: While there was complete adherence to reading the checklist in all operations, the retention of specific details by staff was inconsistent. Although there has been noticeable progress in information retention since 2014, there remains a considerable need for enhancement.