Staff Attitudes and Compliance Toward the Surgical Safety Checklist in North Queensland

Abstract

The Surgical Safety Checklist (SSC) has been reported to decrease complications and mortality; however, it is unclear which aspects are most crucial in producing its associated benefits and whether the positive attitudes of the operating room (OR) staff toward the SSC translates into better checklist compliance. This study aims to compare staff attitudes about reported benefits of and potential barriers to the SSC against observed compliance in 3 multispecialty North Queensland hospitals. SSC compliance, attitudes, and socio-professional factors were assessed via a staff survey consisting of a modified OR version of the Surgical Attitudes Questionnaire. A direct observation study of 165 procedures was concurrently performed to assess compliance with and accuracy of SSC completion at The Townsville Hospital. A total of 205 responses were received (response rate, 70%). Of these, 29.6% of responses were from private hospital staff. Survey responses versus observations indicated a 20% margin between satisfactory initiation and verbal completion of the SSC, with Sign Out both unsatisfactorily initiated (26%) and verbally completed (18%) (P < 0.05). “Staff introduction” was poorly completed and reported as not important (P = 0.005). Disinterest from other staff as perceived by nurses was seen as the greatest barrier to SSC completion. Surgeons and anesthesiologists valued the importance and benefits of the checklist less than half as much as nurses (P < 0.05). The SSC in its present form is not fully embraced in North Queensland hospitals. Making amendments to the checklist and its implementation protocols that reflect local cultural and social settings is desirable to improve compliance.