Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project

M. Lilaonitkul, A. Kwikiriza, S. Ttendo, J. Kiwanuka, E. Munyarungero, I. A. Walker, Kevin D. Rooney

Research output: Contribution to journalArticle

Abstract

The World Health Organization (WHO) Surgical Safety Checklist is a cost-effective tool that has been shown to improve patient safety. We explored the applicability and effectiveness of quality improvement methodology to implement the WHO checklist and surgical counts at Mbarara Regional Referral Hospital in Uganda between October 2012 and September 2013. Compliance rates were evaluated prospectively and monthly structured feedback sessions were held. Checklist and surgical count compliance rates increased from a baseline median (IQR [range]) of 29.5% (0-63.5 [0-67.0]) to 85.0% (82.8-87.5 [79.0-93.0]) and from 25.5% (0-52.5 [0-60.0]) to 83.0% (80.8-85.5 [69.0-89.0]), respectively. The mean all-or-none completion rate of the checklist was 69.3% (SD 7.7, 95% CI [64.8-73.9]). Use of the checklist was associated with performance of surgical counts (p value< 0.001; r(2) = 0.91). Pareto analysis showed that understaffing, malfunctioning and lack of equipment were the main challenges. A carefully designed quality improvement project, including stepwise incremental change and standardisation of practice, can be an effective way of improving clinical practice in low-income settings.
Original languageEnglish
Pages (from-to)1345-1355
JournalAnaesthesia
Volume70
Issue number12
DOIs
Publication statusPublished - 1 Dec 2015

Fingerprint

Uganda
Quality Improvement
Checklist
Surgical Instruments
Referral and Consultation
Safety
Patient Safety
Costs and Cost Analysis
Equipment and Supplies

Keywords

  • SURGERY
  • ANESTHESIA
  • STANDARDS
  • MORTALITY

Cite this

Lilaonitkul, M. ; Kwikiriza, A. ; Ttendo, S. ; Kiwanuka, J. ; Munyarungero, E. ; Walker, I. A. ; Rooney, Kevin D. / Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project. In: Anaesthesia. 2015 ; Vol. 70, No. 12. pp. 1345-1355.
@article{37a799ef21304c4e9fff41bc83ddc5ac,
title = "Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project",
abstract = "The World Health Organization (WHO) Surgical Safety Checklist is a cost-effective tool that has been shown to improve patient safety. We explored the applicability and effectiveness of quality improvement methodology to implement the WHO checklist and surgical counts at Mbarara Regional Referral Hospital in Uganda between October 2012 and September 2013. Compliance rates were evaluated prospectively and monthly structured feedback sessions were held. Checklist and surgical count compliance rates increased from a baseline median (IQR [range]) of 29.5{\%} (0-63.5 [0-67.0]) to 85.0{\%} (82.8-87.5 [79.0-93.0]) and from 25.5{\%} (0-52.5 [0-60.0]) to 83.0{\%} (80.8-85.5 [69.0-89.0]), respectively. The mean all-or-none completion rate of the checklist was 69.3{\%} (SD 7.7, 95{\%} CI [64.8-73.9]). Use of the checklist was associated with performance of surgical counts (p value< 0.001; r(2) = 0.91). Pareto analysis showed that understaffing, malfunctioning and lack of equipment were the main challenges. A carefully designed quality improvement project, including stepwise incremental change and standardisation of practice, can be an effective way of improving clinical practice in low-income settings.",
keywords = "SURGERY, ANESTHESIA, STANDARDS, MORTALITY",
author = "M. Lilaonitkul and A. Kwikiriza and S. Ttendo and J. Kiwanuka and E. Munyarungero and Walker, {I. A.} and Rooney, {Kevin D.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1111/anae.2015.70.issue-12",
language = "English",
volume = "70",
pages = "1345--1355",
journal = "Anaesthesia News",
issn = "0003-2409",
publisher = "The Association of Anaesthetists of Great Britain and Ireland",
number = "12",

}

Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project. / Lilaonitkul, M.; Kwikiriza, A.; Ttendo, S.; Kiwanuka, J.; Munyarungero, E.; Walker, I. A.; Rooney, Kevin D.

In: Anaesthesia, Vol. 70, No. 12, 01.12.2015, p. 1345-1355.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project

AU - Lilaonitkul, M.

AU - Kwikiriza, A.

AU - Ttendo, S.

AU - Kiwanuka, J.

AU - Munyarungero, E.

AU - Walker, I. A.

AU - Rooney, Kevin D.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - The World Health Organization (WHO) Surgical Safety Checklist is a cost-effective tool that has been shown to improve patient safety. We explored the applicability and effectiveness of quality improvement methodology to implement the WHO checklist and surgical counts at Mbarara Regional Referral Hospital in Uganda between October 2012 and September 2013. Compliance rates were evaluated prospectively and monthly structured feedback sessions were held. Checklist and surgical count compliance rates increased from a baseline median (IQR [range]) of 29.5% (0-63.5 [0-67.0]) to 85.0% (82.8-87.5 [79.0-93.0]) and from 25.5% (0-52.5 [0-60.0]) to 83.0% (80.8-85.5 [69.0-89.0]), respectively. The mean all-or-none completion rate of the checklist was 69.3% (SD 7.7, 95% CI [64.8-73.9]). Use of the checklist was associated with performance of surgical counts (p value< 0.001; r(2) = 0.91). Pareto analysis showed that understaffing, malfunctioning and lack of equipment were the main challenges. A carefully designed quality improvement project, including stepwise incremental change and standardisation of practice, can be an effective way of improving clinical practice in low-income settings.

AB - The World Health Organization (WHO) Surgical Safety Checklist is a cost-effective tool that has been shown to improve patient safety. We explored the applicability and effectiveness of quality improvement methodology to implement the WHO checklist and surgical counts at Mbarara Regional Referral Hospital in Uganda between October 2012 and September 2013. Compliance rates were evaluated prospectively and monthly structured feedback sessions were held. Checklist and surgical count compliance rates increased from a baseline median (IQR [range]) of 29.5% (0-63.5 [0-67.0]) to 85.0% (82.8-87.5 [79.0-93.0]) and from 25.5% (0-52.5 [0-60.0]) to 83.0% (80.8-85.5 [69.0-89.0]), respectively. The mean all-or-none completion rate of the checklist was 69.3% (SD 7.7, 95% CI [64.8-73.9]). Use of the checklist was associated with performance of surgical counts (p value< 0.001; r(2) = 0.91). Pareto analysis showed that understaffing, malfunctioning and lack of equipment were the main challenges. A carefully designed quality improvement project, including stepwise incremental change and standardisation of practice, can be an effective way of improving clinical practice in low-income settings.

KW - SURGERY

KW - ANESTHESIA

KW - STANDARDS

KW - MORTALITY

U2 - 10.1111/anae.2015.70.issue-12

DO - 10.1111/anae.2015.70.issue-12

M3 - Article

VL - 70

SP - 1345

EP - 1355

JO - Anaesthesia News

JF - Anaesthesia News

SN - 0003-2409

IS - 12

ER -