Study shows WHO surgical checklist boosts safety, but compliance gaps risk patient outcomes

Editor’s Note

Tertiary hospitals are embracing the World Health Organization (WHO) Surgical Safety Checklist (SSC), yet inconsistent compliance—especially during time-out—exposes patients to avoidable risks, Cureus April 29 reports. In this study, the researchers found that while overall integration of the SSC is promising, there were compliance gaps particularly in pre-incision steps meant to prevent infection, confirm surgical sites, and communicate imaging data.

The researchers evaluated 250 major and minor surgical procedures conducted in a tertiary care hospital over a 3-month period (September to November 2024) to assess adherence to the WHO’s three-phase checklist: sign-in, time-out, and sign-out. According to the article, the sign-out phase—performed just before patients are moved to recovery—showed the highest adherence at 88%. In contrast, time-outs, conducted before the first incision, lagged behind at 68% compliance. The sign-in phase, which includes confirming patient identity and surgical site, fared moderately at 80%.

Despite this, the study notes several troubling oversights: surgical site markings were missing in 58% of applicable cases, and allergy documentation was absent in nearly half. Furthermore, 29% of patients did not receive timely antibiotic prophylaxis, and essential imaging displays were skipped in over half of all procedures.

The article emphasizes that certain safety protocols such as anesthesia checks, team introductions, and communication of critical case details achieved near-perfect adherence. These successes show OR teams are capable of integrating checklist-based habits when supported by training and strong intra-team communication. However, other items like specimen labeling and imaging review fell short, likely due to staffing shortages and procedural lapses during shift transitions.

Checklist implementation is improving surgical outcomes overall, aligning with global findings that tie SSC use to reduced perioperative complications and mortality. Still, the authors caution that partial adherence undermines the tool’s full potential. They advocate for training programs and staff incentives to elevate checklist fidelity and sustain safety culture across all surgical stages.