Compliance Of Healthcare Facilities With WHO's Surgical Safety Checklist: An Annotated Bibliography Essay.

Objectives of the research articles included in the annotated bibliography

Question:

Discuss about the Surgical Safety Checklist by the World Health Organization.

The primary aim pf this research article was to understand the use of surgical safety checklists or SSC in Australian healthcare facilities. After the intervention of SSC by the World Health Organization to reduce the rate of mortality and morbidity, there were very less facts available regarding the use of SSC in Australian healthcare society. The method this study used was direct observation of employees using SSC by trained observers. Further audit was carried out to determine discrepancy in the process and observe the compliance between the practice and the process the healthcare facilities followed. The research was conducted in 11 healthcare facilities and according to the observers, the compliance to the checklist related process was 27%. Within 11 hospitals only 1 hospital was able to comply with the overall process. Further, in maximum of the hospitals, the audit revealed that process and records were not complying with each other. Hence the limitations of the study was the sampling and recruitment process. The goal which was set for the research also limited the scope of the research. the researchers decided to conduct study in 15 hospitals surgical department over 18 months period however, it does not occur as several hospitals prevented external entries within healthcare facilities. Therefore according to my view, this study will provide further scopes for several researches that will arise from the limitation of this study.

The primary objective of this research article was to determine the challenges faced by both low and high income countries while complying with the SSC intervention of the WHO intended to reduce the mortality and morbidity. The research chose UK as the high income country and Africa as the low income country. The study design was Ethnographic that involves observation, interviews and collection of several documents from the healthcare facility. Further for the data analysis section thematic analysis was chosen. The sample size of this research was small and one African hospital and two hospitals of the United Kingdom were chosen to conduct the study. The researchers observed the surgical theatre of these three hospital settings for 112 hours and scrutinized each step to understand the detailed process the facilities followed and found that According to the observers they found maximum compliance between the Who’s SSC and hospitals working environment. However, several steps were conflicting the philosophy of the system because of the difference between the strategy and the local cultural preferences. The limitation was casual and optimistic approach of the healthcare facilities. Hence, the future implication of this research setting in my view is extremely useful and has the ability to inspire many research subjects to find out the shortcomings of this research.

Methodology and findings of each research article

This research was also determined to evaluate the implication of SSC strategy developed by the WHO and find the potential effect related to the checklist compliance. The research was conducted as in Australian healthcare facilities, after the implementation of the SSC, a reduction in the mortality and morbidity rate was observed. Therefore, this retrospective cohort study was conducted with more than 25,000 patients that undergone surgeries in the healthcare facilities of Australia. Further to compare the patients acquired data, the electronic data was also collected from the healthcare facilities. Further several aspects such as patient outcomes, patient characteristics, surgical specialty, and comorbidity was also checked. The findings also indicated to the fact that crude morbidity reduced to 2.85% from 3.13% after the implementation of surgical safety checklist in the healthcare settings. Further from the patients responses it was determined that 96% patient responded that healthcare facilities complied with the WHO’s SSC strategy. However the limitation of the study was biasness of patients and the refusal of several healthcare facilities to provide their patients electronic information to the researchers. Although the future implication of the study is positive as the study provided scope for future researches where possible bias and other inhibiting factors can be removed.

In this research article the aim was to determine the effect of WHO’s SSC Checklist as the healthcare facilities proposed that due to proper use of this check list morbidity and mortality rates decreased in their facilities. Further the research also find out the type of SSC program that is dependent to WHO or independent SSC was conducted in the healthcare facilities. The objectives were to compare one hospital having WHO supported SSC practice and another hospital having independent SSC practice. The method that was chosen for this research was observational and all three SSC domains such as sign in time out and sign out was observed in both the healthcare facilities. As well as they also observed the team engagement within the operation theatre. The research article presented findings depending on the three aspects of sign in, time out and sign out. In case of sign in, the compliance of hospital 1 and 2 was 96% and 31% respectively, for time out it was 99% and 48% respectively and for sign out 22% and 9% respectively. Therefore the findings were very clear that hospitals that conducted SSC process without the help of WHO were unable to comply with the process however the team engagement in the hospital 2 was better than hospital 1. Hence, the future implication of this research study is progressive as further research can be conducted on the conflict between team engagement and compliance with SSC of WHO.

Limitations of the research articles

The aim of this research article was to understand the issues that the healthcare facilities faced while complying with the WHO driven surgical safety checklist process to reduce the mortality and morbidity rates while the process of crucial surgeries. Further to understand the communication related issues, medical failures and support development while implementing the intervention in the healthcare facility. The objective of this research was to assess the level of deviation to the SSC process. The method was observation of the surgical site and for the purpose 24 surgical procedures in different healthcare facilities were observed. Within the healthcare settings, the observer decided to observe the three processes such as sign in, time out and sign out. However, as the maximum rate of error occurred in time out phase of surgical setting, the process of time out was specially analyzed so that compliance with the predefined observational protocol can be observed. It was observed that high compliance with the SSC protocol are being followed by the healthcare facilities. Further it was observed that the healthcare professionals mainly the surgeons and anaesthesia team dominated the time out process, which was the limitation of the study. Further the future implication of the study included research on other aspects such as sign in and sign out. 

The surgical safety checklist was developed by the World Health Organization as a tool to be used in the hospital surgical rooms while surgeries so that the morbidity and mortality rates can be decreased. According to this tool, the organization was responsible for any incident occurred in the healthcare facility and it is the duty of the healthcare experts present within the room to apply all the safety measures according to SSC. In this assignment, five research articles were collected that provided detailed idea regarding the SSC compliance of healthcare facilities. Further in this assignment, the overall findings of those five articles will be analyzed, synthesized and criticized.

All the articles included in the annotated bibliography were focused to understand the level of compliance of healthcare facilities with the SSC tool. The first article by Giles et al., (2017), determined the understanding of Australian hospitals regarding the topic and found that Maximum of the healthcare facilities were not being able to comply with the SSC tool. Further According to Sparks et al., (2013), independent healthcare systems are the ones that are unable to comply with the SSC tool. Further the research article had several limitation such as sampling and recruitment issues, hence while critically analyzing the data of article it was determined that maximum of the healthcare facilities di not allowed the researchers to conduct research within surgical theatre, hence the authenticity of the results are primary concern. Further in the articles by Aveling, McCulloch & Dixon-Woods, (2013) and Hannam et al., (2013), the challenges faced by healthcare facilities during complying with the SSC tool was determined. In the article of Hannam et al., (2013), issues regarding WHO support and WHO independent SSC compliance was compared and it was found that independent hospitals lack the ability to comply with the process. Hence, according to Pollach & Namboya (2013), lack of experience and training the facility was unable to follow the steps provided by WHO. Whereas Aveling, McCulloch & Dixon-Woods (2013) conducted research to understand the internal issues that distract facilities to comply with the process due to high income or low income.  Further Care & Knowledge (2014) also determined that GDP of the country is responsible for the development of the healthcare facility hence the results were critically correct.

Future implications of the research articles

The fourth article was regarding a cohort study that was conducted by Van Klei et al., (2012) with the patients and healthcare electronic records to understand the level of compliance. However, it was seen that due to individual bias and inability of the researchers to use HER records of each patient the authenticity of the work hampered. However the main aspect of the study was to observe the reduction of morbidity rates which was observed from the result. Finally in the research conducted by Rydenfält et al., (2013), in which the issues faced by healthcare facilities in each aspect of SSC such as sign in, time out and sign out was discussed. Further from the result was observed that time it was dominated by senior healthcare experts that violated the SSC guidelines. Hence, critically, it was non-compliance with the study.

While concluding it can be said that the healthcare facilities were unable to comply with the SSC tool as they lacked proper training and brief introduction on organization level as the application of theoretical knowledge on healthcare environment was difficult for them. However, all these research articles provided positive future implication as more research could have been conducted on the limitations of these researches to make the healthcare facilities completely compliance with the SSC tool.

References

Aveling, E. L., McCulloch, P., & Dixon-Woods, M. (2013). A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries. BMJ open, 3(8), e003039.

Care, E. V. B., & Knowledge, G. N. (2014). Center for Nursing Research, and Louisiana State University Health Sciences Center, School of Nursing New Orleans, LA. The Ochsner Journal, 14, e25-e38.

Giles, K., Munn, Z., Aromataris, E., Deakin, A., Schultz, T., Mandel, C., ... & Runciman, W. (2017). Use of surgical safety checklists in Australian operating theatres: an observational study. ANZ journal of surgery, 87(12), 971-975.

Hannam, J. A., Glass, L., Kwon, J., Windsor, J., Stapelberg, F., Callaghan, K., ... & Mitchell, S. J. (2013). A prospective, observational study of the effects of implementation strategy on compliance with a surgical safety checklist. BMJ Qual Saf, bmjqs-2012.

Pollach, G., & Namboya, F. (2013). Preventing intensive care admissions for sepsis in tropical Africa (PICASTA): an extension of the international pediatric global sepsis initiative: an African perspective. Pediatric Critical Care Medicine, 14(6), 561-570.

Rydenfält, C., Johansson, G., Odenrick, P., Åkerman, K., & Larsson, P. A. (2013). Compliance with the WHO Surgical Safety Checklist: deviations and possible improvements. International Journal for Quality in Health Care, 25(2), 182-187.

Sparks, E. A., Wehbe-Janek, H., Johnson, R. L., Smythe, W. R., & Papaconstantinou, H. T. (2013). Surgical safety checklist compliance: a job done poorly!. Journal of the American College of Surgeons, 217(5), 867-873.

Van Klei, W. A., Hoff, R. G., Van Aarnhem, E. E. H. L., Simmermacher, R. K. J., Regli, L. P. E., Kappen, T. H., ... & Peelen, L. M. (2012). Effects of the introduction of the WHO “Surgical Safety Checklist” on in-hospital mortality: a cohort study. Annals of surgery, 255(1), 44-49.