Global Adoption and Modification of the World Health Organization (WHO) Surgical Safety Checklist

Abstract

Purpose: To understand how hospitals have modified the checklist globally. Methods: 126 checklists were studied from 37 countries and 19 US states. Checklists were analyzed for trend and were provided a teamwork score based on how many communication items were retained. Checklists modifications were aggregated and analyzed geographically. Results: Modified checklists contained more total items as compared to the original, averaging 33.5 ±8.4 items versus 28 in the original. The most commonly added items were procedural, not teamwork-based. 50% of all checklists removed two or more of the original seven teamwork items. Surgeon-led items were more likely to be removed. The average number of teamwork items on US checklists was significantly lower than on non–US checklists (3.98 vs. 5.64, p<0.05). US checklists were also more likely to eliminate all surgeon-led items (21.4% of US vs. 12.7% of all checklists). Conclusions: Checklists should strike a balance between critical items and teamwork checks, meanwhile ensuring the checklist is feasible in length. Hospitals, while eager to add items, are primarily adding procedural checks, but not necessarily preserving essential teamwork and surgeon-led items. We recommend hospitals preserve all teamwork and surgeon-led items, but limit checklist length to ensure feasibility.