チェックリストで手術の安全性を向上させる

タイトル: Quality Improvement (QI) Project: Enhancing Surgical Safety Checklist Utilization at a Rural Primary Hospital

概要: BackgroundDespite evidence demonstrating the benefits of the World Health Organization (WHO) Surgical Safety Checklist (SSC), its utilization is less frequent in countries with a lower Human Development Index (HDI). This quality improvement project aimed to enhance SSC utilization in a rural primary hospital to address critical issues, including inconsistent administration of prophylactic antibiotics, frequent instances of lost or mislabeled surgical specimens, and inadequate preparedness for essential surgical instruments and blood products. MethodsThis quality improvement project was conducted at a Primary Hospital, a rural facility in Ethiopia, to address suboptimal utilization of the WHO Surgical Safety Checklist (SSC). The surgical team included 2 specialists, 2 anesthetists, and 5 nurses, with an average SSC utilization rate of 50% and a completion rate of 80% over the prior 18 months. A Plan-Do-Study-Act (PDSA) approach was employed to enhance adherence. Key interventions included translating the SSC into Amharic, conducting a two-day training session, introducing pre- and post-operative briefings, and requiring surgeons to remain in the operating room until checklist completion. Bi-weekly audits and regular supervision were conducted to monitor progress, with feedback loops established to guide adjustments. The effectiveness of the intervention was assessed through quantitative and qualitative methods. Key performance indicators included SSC utilization and completion rates, with secondary metrics such as prophylactic antibiotic administration and surgical site infection rates. Trend analysis using run charts and Interrupted Time Series (ITS) analysis evaluated changes over time, while staff interviews provided insights into behavioral and attitudinal shifts. Sustained improvements were reinforced through ongoing training, monthly supervision, and staff recognition initiatives. ResultsThe quality improvement project demonstrated a significant and sustained improvement in the utilization and completion rates of the WHO Surgical Safety Checklist (SSC). Baseline measurements in October 2023 showed a utilization rate of 53% and a completion rate of 65%. Following targeted interventions, both metrics steadily improved, reaching 100% by June 2024 and maintaining this level through September 2024. ConclusionThe QI project demonstrated that achieving 100% utilization and completion of the WHO Surgical Safety Checklist (SSC) is feasible even in rural hospitals of low- and middle-income countries (LMICs). Formal training proved crucial for improving adherence, addressing gaps seen with informal approaches, and fostering better team communication and culture. Challenges such as incomplete Sign-out sections and language barriers were mitigated by adapting the SSC to local contexts, including translation. These findings highlight the importance of structured interventions and localized solutions in enhancing surgical safety practices and inspire broader implementation in similar resource-limited settings.