Background Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships.
Methods A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects.
Results 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC’s influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators.
Conclusion There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.
- safety culture
Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information.
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Contributors BAA (guarantor): idea generation, study screening, data extraction, analysis, risk of bias assessments, manuscript writing and revisions. IAD: study screening, data extraction, analysis, risk of bias assessments, manuscript writing and revisions. LN: idea generation, study screening, data extraction, analysis, manuscript writing and revisions. EB: study screening, data extraction and manuscript revisions. DNC: study screening, data extraction, manuscript writing and revisions. K-DN: study screening and data extraction. SB, PT: manuscript writing and revisions. VP: idea generation, manuscript writing and revisions.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Dr. Boet's research is supported by The Ottawa Hospital Anesthesia Alternate Funds Association and the Faculty of Medicine, University of Ottawa with a Tier 2 Clinical Research Chair.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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