Key result
A targeted quality improvement project, including staff training and workflow adjustments, increased the utilization rate of the WHO Surgical Safety Checklist from 53% at baseline to 100%.
Why the study?
Despite known benefits of the WHO Surgical Safety Checklist, its utilization is less frequent in low- and middle-income countries, with suboptimal baseline utilization observed at a rural Ethiopian hospital.
Does a targeted PDSA quality improvement intervention improve the utilization and completion rates of the WHO Surgical Safety Checklist in a rural hospital in Ethiopia?
Does a targeted PDSA quality improvement intervention improve the utilization and completion rates of the WHO Surgical Safety Checklist in a rural hospital in Ethiopia?
Absolute Event Rate: 100% vs 53%
A structured quality improvement intervention, including local language translation and formal training, successfully achieved and sustained 100% utilization and completion of the WHO Surgical Safety Checklist in a rural Ethiopian hospital.
QIP feasibility in rural Ethiopia supports targeted SSC efforts; leaves open scalability and sustainability in LMICs.
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.
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Gemechu et al. (2024) studied Patients undergoing surgical procedures. Quality improvement bundle (SSC translation, training, briefings, workflow adjustments) vs. Baseline (pre-intervention period) was evaluated on Utilization rate of the WHO Surgical Safety Checklist (SSC). A targeted quality improvement project, including staff training and workflow adjustments, increased the utilization rate of the WHO Surgical Safety Checklist from 53% at baseline to 100%.
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