<h4>Objective</h4>A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.<h4>Background</h4>With the aim of increasing patient safety, checklists have gained growing attention. Information about effectiveness, compliance, and critical factors for implementation is crucial for whether and which of the available instruments to use.<h4>Data sources</h4>Medline including Premedline (OvidSP), Embase, and Cochrane Collaboration Library, hand search, a search of reference lists of key articles, and tables of content.<h4>Study selection</h4>Electronic databases returned 4997 citations, of which 84 articles were chosen for full-text review. Finally, 22 articles were included in this review.<h4>Data extraction</h4>Data relating to care setting, study methods and design, sample population, survey response rate, type of checklist, aim, effectiveness, compliance, attitudes, and critical factors were extracted from the studies. A random effects meta-analysis of effectiveness data was conducted if 2 or more studies reported a specified outcome.<h4>Results</h4>With the use of checklists, the relative risk for mortality is 0.57 [95% confidence interval (CI): 0.42-0.76] and for any complications 0.63 (95% CI: 0.58-0.67). The overall compliance rate ranged from 12% to 100% (mean: 75%) and for the Time Out from 70% to 100% (mean: 91%).<h4>Conclusions</h4>Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed.

Existing evidence suggests that communication failures are common in the operating room, and that they lead to increased complications, including infections. Use of a surgical safety checklist may prevent communication failures and reduce complications. Initial data from the World Health Organization Surgical Safety Checklist (WHO SSC) demonstrated significant reductions in both morbidity and mortality with checklist implementation. A growing body of literature points out that while the physical act of "checking the box" may not necessarily prevent all adverse events, the checklist is a scaffold on which attitudes toward teamwork and communication can be encouraged and improved. Recent evidence reinforces the fact the compliance with the checklist is critical for the effects on patient safety to be realized.

ObjectiveTo examine whether the use of a surgical safety checklist (SSC) could reduce the incidence of complications after small animal surgery.Study DesignProspective clinical study.Animals: Client‐owned dogs and cats (n = 520).MethodsConsecutive cases were enrolled in the study, the first 300 cases without implementation of the surgical checklist (SSC−), followed by 220 cases with implementation of the checklist (SSC+). The checklist was adapted from the WHO surgical checklist and consisted of three different check points: (1) before induction of anaesthesia (sign in), (2) before surgical incision (time out), and (3) before recovery (sign out). In‐hospital outcomes were prospectively recorded, and complications within 6 weeks were retrospectively recorded by reviewing medical records and by telephone interviews with owners. The severity of each recorded complication was graded as minor, moderate, or severe. Comparisons were made between SSC− and SSC+ outcomes.ResultsThere were significantly more complications in SSC− animals than SSC+ animals (SSC− 52/300 vs. SSC+ 15/220, P = .0003). There was a significantly higher frequency of SSI (P = .045) and wound healing complications (P = .0006) for SSC− animals than SSC+ animals.ConclusionThe frequency and severity of postoperative complications was significantly decreased after introduction of a surgical checklist. All veterinary hospitals should consider using a surgical checklist. Compliance with implementation of the checklist is important for success.

INTRODUCTION To determine whether use of a surgical safety checklist (SSC) would reduce the rate of major complications after permanent transvenous pacemaker implantation in dogs. ANIMALS The study included one hundred ninety-nine dogs undergoing pacemaker implantation for bradyarrhythmias at an academic teaching hospital. METHODS A service-specific SSC was developed and implemented for cardiac catheterization procedures in 2015. Medical records were reviewed to extract relevant clinical and procedural data for cases with (SSC [+]) and without (SSC [-]) a checklist. Owners or referring veterinarians were contacted for outcome and survival data. RESULTS Major complications occurred in 25/199 (12.6%) dogs. Incidence of major complications was significantly lower in SSC [+] dogs compared with SSC [-] dogs (1/45 procedures vs 24/144 procedures; p = 0.019). Dogs with SSCs were more likely to receive antibiotics within 5 min of the first incision (p = 0.0082) and to receive antibiotics every 90 min throughout the procedure as prescribed (p = 0.001) compared with dogs without SSCs. Incidence of cardiac death was lower in SSC [+] dogs compared with SSC [-] dogs (p = 0.0012), but checklist use was not associated with increased survival time (all-cause or cardiac). On average, 91% of checklist components were completed for each SSC; minor changes in record-keeping protocols could increase compliance. CONCLUSIONS Use of an SSC was associated with a decrease in the major complication rate and an increase in compliance with antibiotic protocols during pacemaker implantation. Results of this study support the use of an SSC in veterinary cardiology procedures.

Surgical errors and preventable harm remain major public health concerns, especially in the low- and middle-income countries (LMICs). The World Health Organization's Surgical Safety Checklist (SSC) was developed as a low-cost, high-impact tool to improve surgical outcomes and enhance patient safety. This review examines how the SSC functions both as a safeguard against preventable errors and as a driving force for reducing morbidity and mortality in surgical care. Drawing on evidence from LMICs, we examine the checklist's impact on reducing surgical errors, associated complications, morbidity, and mortality, while also fostering better team communication and accountability in operating rooms. Despite SSC's proven benefits, its implementation in LMICs remains inconsistent due to barriers such as hierarchical team dynamics, limited training, infrastructure gaps, and lack of leadership support. The article highlights approach such as including structured training programs, hands-on demonstrations, workshops and the use of digital tools and platforms for better SSC implementation. It also emphasizes the role of local champions, leadership endorsement, local adaptations and regular audits with feedback to sustain adherence and foster a culture of surgical safety. Strengthening these efforts can transform the SSC from a procedural formality into a powerful tool for surgical safety, providing a practical pathway to enhance patient safety and quality in global surgical care.

<h4>Background</h4>Surgical safety is a global health priority, yet its consistent application in low- and middle-income countries remains a challenge due to systemic, cultural, and resource-related barriers. The World Health Organization's Surgical Safety Checklist (SSC) has been shown to reduce perioperative complications, but evidence from fragile health systems such as Somalia remains scarce.<h4>Methods</h4>This prospective closed-loop clinical audit was conducted at Dr. Sumait Hospital, a tertiary referral and teaching facility in Mogadishu, Somalia. A total of 160 surgical procedures were observed across two audit cycles. The first cycle established baseline compliance, while the second followed a structured intervention comprising targeted staff education sessions, strengthened leadership involvement, and placement of visual reminders and wall posters in operating theatres. Checklist adherence was assessed across the sign in, time out, and sign out phases using a standardized 25-item observation tool. Data were analyzed using the Wilcoxon signed-rank test, with significance set at p < 0.05.<h4>Results</h4>Overall checklist compliance increased significantly from 51.38% in the first cycle to 93.01% in the second (p < 0.001). Improvements were observed across all three SSC phases: sign in compliance rose from 54.62% to 88.19%, time out compliance from 50.60% to 96.94%, and sign out compliance from 47.29% to 95.01%. The most substantial gains were linked to improved team communication during the time out phase. However, checklist items requiring anticipatory planning, such as risk assessment for major blood loss, showed relatively lower improvements.<h4>Conclusion</h4>Context-sensitive, low-cost interventions-including focused education, leadership reinforcement, and visual prompts-can markedly improve adherence to the WHO Surgical Safety Checklist in resource-limited settings. These findings underscore the SSC's potential to strengthen surgical safety culture in Somalia and offer a practical model for similar fragile health systems aiming to reduce preventable perioperative harm.

The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.

antibiotics, use of the WHO Surgical Safety Checklist, and vigilant post-operative monitoring greatly reduce the risk of these complications. Planned surgery The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (see stomach, kidney, liver, etc.) Diseases affecting the abdominal cavity are dealt with generally under their own names. Adhesions (also called scar tissue): complications of postoperative adhesion formation are frequent, they have a large negative effect on patients' health, and increase workload in clinical practice Bleeding Infection Paralytic ileus: short-term paralysis of the bowel Perioperative mortality, any death occurring within 30 days after surgery Shock Sterile technique, aseptic post-operative care, antibiotics, use of the WHO Surgical Safety Checklist, and vigilant post-operative monitoring greatly reduce the risk of these complications. Planned surgery performed under sterile conditions is much less risky than that performed under emergency or unsterile conditions. The contents of the bowel are unsterile, and thus leakage of bowel contents, as from trauma, substantially increases the risk of infection. Globally, there are few studies comparing perioperative mortality following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency laparotomy from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent). Of the 578 patients who died, 404 (69.9 percent) did so between 24 hours and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days. Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1,000 procedures performed in these settings. Internationally, the most common operations performed were…

Introduction: Despite increased focus on patient safety, complication rates in hospitals have remained unchanged with reports ranging between one out of twenty patients and one out of four patients, often related to surgery. However, half of the complications may be prevented throughout the surgical pathway. To inform and study effects of targeted patient safety interventions requires patient outcome data of high accuracy. Introduction of the World Health Organization surgical safety checklists (WHO SSC) has been reported to increase safety, also in our hospital. Aims: The overall objective for the study was to investigate effects of using safety checklists on patient outcomes in medicine. Further, to evaluate effects of adding a validated Norwegian version of the pre- and postoperative parts of the SURPASS checklists in combination with the established WHO SSC on emergency reoperations, 30-day unplanned readmissions, 30-day mortality and length of hospital stay, in addition to verified in-hospital complications using a reliable and validated method. Methods: In the first study, we conducted a systematic literature search in Cochrane Library, MEDLINE, EMBASE and Web of Science on effects on patient outcomes of using safety checklists in medicine. Following the PRISMA guidelines ensured transparency of reporting. The studies were eligible if they quantitatively reported possible effects of using safety checklists. In the second study, validation of a Norwegian version of the p

BackgroundStudies have demonstrated that surgical safety checklists (SSCs) can significantly reduce surgical complications and mortality rates. Such lists rely on traditional posters or paper, and their contents are generic regarding the type of surgery being performed. SSC completion rates and uniformity of content have been reported as modest and widely variable. ObjectiveThis study aimed to investigate the feasibility and potential of using smart glasses in the operating room to increase the benefits of SSCs by improving usability through contextualized content and, ideally, resulting in improved completion rates. MethodsWe prospectively evaluated and compared 80 preoperative time-out events with SSCs at a major academic medical center between June 2016 and February 2017. Participants were assigned to either a conventional checklist approach (poster, memory, or both) or a smart glasses app running on Google Glass. ResultsFour different surgeons conducted 41 checklists using conventional methods (ie, memory or poster) and 39 using the smart glasses app. The average checklist completion rate using conventional methods was 76%. Smart glasses allowed a completion rate of up to 100% with a decrease in average checklist duration of 18%. ConclusionsCompared with alternatives such as posters, paper, and memory, smart glasses checklists are easier to use and follow. The glasses allowed surgeons to use contextualized time-out checklists, which increased the completion rate to 100% a

Background: The 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypo

Reducing Deaths After Surgery in Low- and Middle-income Countries: A Pilot Cluster Randomised Trial SurgPASS is a pilot randomised cluster trial utilising a pre-operative checklist with the aim of reducing deaths after surgery. If SurgPASS is successful, the intervention will be implemented in a separate full-scale cluster randomised trial. Title: Reducing deaths after surgery in low- and middle-income countries: A pilot cluster randomised trial Aim: This pilot randomised cluster trial aims to evaluate the feasibility of a large-scale cluster randomised trial to assess the effectiveness and implementation of a pre-operative checklist to reduce deaths after surgery. If this pilot study is successful, we aim to assess the intervention in a separate full-scale cluster randomised trial. * Objective 1: To determine feasibility and fidelity of delivering the intervention. * Objective 2: To determine the rate recruitment to inform how long it will take to recruit to a future cluster randomised trial. * Objective 3: To obtain information on postoperative outcomes to help inform the outcomes used and sample size of the future cluster randomised trial.