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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Addressing knowledge gaps in Surgical Safety Checklist use: statistical process control analysis of a surgical quality improvement programme in Ethiopia
British Journal of Surgery, Volume 110, No. 11, Year 2023
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Description
Background: The WHO Surgical Safety Checklist reduces morbidity and mortality after surgery, but uptake remains challenging. In particular, low-income countries have been found to have lower rates of checklist use compared with high-income countries. The aim of this study was to determine the impact of educational workshops on Surgical Safety Checklist use implemented as part of a quality improvement initiative in five hospitals in Ethiopia that had variable experience with the Surgical Safety Checklist. Methods: From April 2019 to September 2020, each hospital implemented a 6-month surgical quality improvement programme, which included a Surgical Safety Checklist workshop. Statistical process control methodology was used to understand the variation in Surgical Safety Checklist compliance before and after workshops and a time-series analysis was performed using population-averaged generalized estimating equation Poisson regression. Checklist compliance was defined as correctly completing a sign in, timeout, and sign out. Incidence rate ratios of correct checklist use pre- and post-intervention were calculated and the change in mean weekly compliance was predicted. Results: Checklist compliance data were obtained from 2767 operations (1940 (70 per cent) pre-intervention and 827 (30 per cent) post-intervention). Mean weekly checklist compliance improved from 27.3 to 41.2 per cent (mean difference 13.9 per cent, P = 0.001; incidence rate ratio 1.51, P = 0.001). Hospitals with higher checklist compliance at baseline had the greatest overall improvements in compliance, more than 50 per cent over pre-intervention, while low-performing hospitals showed no improvement. Conclusion: Surgical Safety Checklist workshops improved checklist compliance in hospitals with some experience with its use. Workshops had little effect in hospitals unfamiliar with the Surgical Safety Checklist, emphasizing the importance of multifactorial interventions and culture-change approaches. In receptive facilities, short workshops can accelerate behaviour change. © The Author(s) 2023.
Authors & Co-Authors
Starr, Nichole E.
United States, Bethesda
Fogarty International Center
Ethiopia, Addis Ababa
Lifebox Foundation
United States, San Francisco
University of California, San Francisco
Mammo, Tihitena Negussie
Ethiopia, Addis Ababa
Lifebox Foundation
Ethiopia, Addis Ababa
Addis Ababa University
Trickey, Amber Williams
United States, Palo Alto
Stanford University
Gebeyehu, Natnael Atnafu
Ethiopia, Addis Ababa
Lifebox Foundation
United States, San Francisco
University of California, San Francisco
Koritsanszky, Luca Anna
United States, Boston
Boston Medical Center
Tara, Mansi
Ethiopia, Addis Ababa
Lifebox Foundation
Alemu, Senait Bitew
Ethiopia, Addis Ababa
Lifebox Foundation
Evans, Faye M.
Ethiopia, Addis Ababa
Lifebox Foundation
United States, Boston
Boston Children's Hospital
United States, Boston
Harvard Medical School
Weiser, Thomas G.
United States, Palo Alto
Stanford University
Ethiopia, Addis Ababa
Lifebox Foundation
Statistics
Citations: 2
Authors: 9
Affiliations: 9
Identifiers
Doi:
10.1093/bjs/znad234
ISSN:
00071323
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Locations
Ethiopia