SP2.2.10Barriers to Compliance of the WHO Safe Surgical Checklist in an Ethiopian Tertiary Referral Centre

Aims Ethiopia is the world’s 12th most populous country, with a health care system currently undergoing significant development. Current data shows perioperative mortality at 7%, compared to the 0.4– 0.8% reported in more economically developed countries. In 2008 the WHO created the Safe Surgical Checklist (SSC), globally shown to dramatically improve perioperative mortality and used throughout Ethiopia since 2010. The author aimed to review compliance to this checklist within emergency theatres in Ethiopia and assess potential barriers to its use. Methods A prospective observational study was undertaken at Felege Hiwot Referral Hospital, a tertiary referral hospital in Northwest Ethiopia, over a six-week period. 70 emergency operations were directly observed. Results The SSC was used in 0 out of 70 cases, no surgical pauses were observed and during each operation, a member of the anaesthetic team was observed to tick each box incorrectly as completed while finalising paperwork at the end of the case. Interviews with surgical and anaesthetic staff members revealed poor compliance to be secondary to a lack of knowledge of the benefits of the checklist and no training in its use. Conclusions After its introduction in 2008 compliance with SSC was poor globally, with the published data revealing this to be secondary to poor initial implementation from senior hospital staff and a lack of staff training. While compliance has improved in more economically developed countries, the same barriers are still faced in Ethiopia. These barriers must be targeted in order to improve perioperative outcomes.