Effect of surgical safety checklists on postoperative morbidity and mortality rates, Shiraz, Faghihy Hospital, a 1-year study

Qual Manag Health Care. 2011 Oct-Dec;20(4):293-7. doi: 10.1097/QMH.0b013e318231357c.


Objective: The study intent was to (1) encourage the use of surgical safety checklists and (2) measure the effect checklists have in reducing surgical complications.

Design: An interventional study designed to improve postsurgical outcomes was performed.

Setting: The study site was a 374-bed referral educational hospital in Shiraz, Iran, with 6 operating rooms. The study lasted 6 months.

Participants: Patient selection involved a convenient sampling method with all eligible patients entering.

Intervention: Our checklist covered 3 surgical stages--before anesthesia, immediately before an incision, and before moving the patient to a recovery room. Persons included were operating room team members.

Main outcome measures: Rates of postsurgical complication before and after application of the surgical safety checklist underwent comparison.

Results: Incidence of any complication before and after intervention was 22.9% and 10% (P = .03). Five checklist items were in total compliance. The most common complication was surgical site infection. Implementation of the checklist, responsibility in 2 stages, such as time out and sign out, were significant (P < .05). In most cases, these items reflected the performance of surgeons and anesthesia professionals as compared with the World Health Organization Surgical Safety Checklist.

Conclusion: Complications decreased by 57% after intervention. Both high patient information detection and elevated levels of cooperation by surgical personnel were observed. Compliance likely helped prevent some adverse effects associated with surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Checklist / methods*
  • Comorbidity
  • Female
  • Humans
  • Iran
  • Male
  • Middle Aged
  • Patient Safety
  • Postoperative Complications / mortality*
  • Postoperative Complications / prevention & control*
  • Postoperative Period
  • Surgical Procedures, Operative / methods*