WHO’s surgical safety checklist: it ain’t what you do . . .BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2237 (Published 20 May 2019) Cite this as: BMJ 2019;365:l2237
All rapid responses
After reading in the medical staff of the Dr. Gustavo Aldereguía University General Hospital in Cienfuegos, Cuba, the article published in BMJ: WHO's surgical safety checklist: it is not what you do. . ., We decided to express our experiences in this first decade of this program established in our hospital.
In global terms, about 234 million major surgery operations are performed annually, which is approximately one operation per 25 people. Every year, 63 million people with traumatic injuries, 10 million women with complications related to pregnancy and 31 million patients who require oncological treatment are operated. According to several studies, the complications attributable to surgical interventions cause disabilities or prolong the hospitalization of between 3% and 25% of patients, depending on the complexity of the operation and the hospital environment. This means that the number of patients susceptible to suffering postoperative complications is at least 7 million per year.
In 2008, when the alliance for Patient Safety was created by the WHO, our Collaborating Center of the aforementioned world organization gradually incorporated the different patient safety programs already designed.
One of the first programs implemented was the Safe Surgery in the right place, after having trained all the personnel related to the surgical activity of our hospital, tested their protocols and audited the process; and after 10 years of existence we can share the following achievements:
• Check List and informed consent models were established.
• Instructive talks were given to the staff of the operating rooms.
• A set of organizational measures were taken within the operating rooms to obtain the expected results, once the program application was implemented.
• Educational talks were held with the staff of the surgical services emphasizing the importance of the use of the program and the consequent benefits.
• An updated and comprehensive antibiotic prophylaxis guide was created for all surgical services, which favored the evolution of patients and prevented the indiscriminate administration of antibiotics.
• A new evaluation of the operating rooms, more complete and organized.
Results of this program were disseminated in national and international workshops, congresses, which have motivated debates and expectations on the part of the participants and the Cuban Society of Surgery, leaving our hospital as a national reference institution for patient safety. The National Congress of Surgery decided as a motto: "For ethics and safety for the patient".
We must all work so that the patient is the center of attention and each day reduce the risks so that they do not become damages when attending to them in our health institutions.
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Competing interests: No competing interests
I agree with Greta McLachlan that the WHO Surgical Safety Checklist can only improve outcomes for surgical patients when used in a systematic rather than adhoc approach (BMJ 2019;365:l2237). I was therefore rather surprised and disappointed that there was no reference to the recent article in the British Journal of Surgery, by Ramsay et al, “Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist”.
This demonstrated a 36.6% reduction in post-operative mortality, between 2008 and 2011, when the checklist was implemented Scotland-wide as part of the overarching Scottish Patient Safety Programme (SPSP).
While improving patient safety during surgery was the first work-stream of the SPSP, it has been rolled out across many specialities and into primary care; delivering a reduction in overall hospital deaths and stillbirths as well as complications such as sepsis and pressure sores.
The extensive involvement of frontline staff, in the development of the SPSP, is key to its ongoing success; creating Patient Safety Champions throughout NHS Scotland.
Competing interests: No competing interests