Verbal application of the Surgical Safety Checklist: a critical analysis of the practice
DOI:
https://doi.org/10.5327/Z1414-44251083Keywords:
Checklists, Patient safety, Time out, Operating rooms, Perioperative nursingAbstract
Objective: To analyze the compliance of the Surgical Safety Checklist application, with emphasis on verbal confirmation, in a public teaching hospital. Methods: This is a descriptive, cross-sectional study with a quantitative approach, based on direct observation of 193 surgical procedures performed between April and August 2025. Compliance was defined as performing both verbal confirmation and documentation for each item. Data were analyzed using descriptive and univariate statistics, employing an instrument developed by the researcher based on the World Health Organization’s standard Surgical Safety Checklist, which includes fields to record verbal confirmation of each item, documentation in the medical record, and completion of the checklist steps. The study was approved by the Research Ethics Committee of the institution hosting the study, via Plataforma Brasil (CAAE 86548025.7.0000.5133; Opinion No. 7.500.360), and all participants signed the Informed Consent Form. Results: In this study, the highest compliance rates were observed during the first phase of the Checklist, particularly in confirming patient identity, surgical site, procedure, and verifying the signed consent form. This finding suggests that professionals tend to prioritize actions with greater ethical and legal relevance over the technical aspects of the surgical process. Documentation compliance was significantly more frequent (p<0.05) than verbal confirmation, indicating a predominantly bureaucratic adherence to the tool. Overall compliance was low and decreased across the three phases: sign in (22.16%), timeout (16.11%), and sign out (9.40%). Conclusion: We demonstrated low compliance with applying the Surgical Safety Checklist aloud, with a progressive reduction in checking across the three phases and predominantly bureaucratic use, at the expense of its preventive and communicative purpose.
References
1. Villar VCFL, Duarte SCM, Martins M. Segurança do paciente no cuidado hospitalar: uma revisão sobre a perspectiva do paciente. Cad. Saúde Pública. 2020;36(12):E00223019. https://doi.org/10.1590/0102-311X00223019 DOI: https://doi.org/10.1590/0102-311x00223019
2. World Health Organization. Patienty safety: safe surgery saves lives [Internet]. Geneva: WHO; 2013. [accessed on July 10, 2025]. Available at: https://www.who.int/news-room/questions-and-answers/item/safe-surgery-saves-lives-frequently-asked-questions
3. Habtie TE, Feleke SF, Terefe AB, Adisu MA. Beyond compliance: examining the completeness and determinants of WHO surgical safety checklist: a systematic review and meta-analysis. BMC Health Serv Res. 2025;25(1):504. https://doi.org/10.1186/s12913-025-12569-0 DOI: https://doi.org/10.1186/s12913-025-12569-0
4. Silva EFM, Calil ASG, Araujo CS, Ruiz PBO, Jericó MC. Conhecimento dos profissionais da saúde sobre checklist de cirurgia segura. Arq Ciênc Saúde. 2017;24(3):71-8. DOI: https://doi.org/10.17696/2318-3691.24.3.2017.731
5. Poveda VB, Lemos CS, Lopes SG, Pereira COM, Carvalho R. Implementação de checklist de segurança cirúrgica no Brasil: estudo transversal. Rev Bras Enferm. 2021;74(2):e20190874. https://doi.org/10.1590/0034-7167-2019-0874 DOI: https://doi.org/10.1590/0034-7167-2019-0874
6. Ribeiro L. Adesão e efeito do checklist de cirurgia segura na incidência de eventos adversos entre pacientes cirúrgicos. [tese]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2019.
7. Marquioni FSN, Moreira TR, Diaz FBBS, Ribeiro L. Cirurgia segura: avaliação da adesão ao checklist em hospital de ensino. Rev SOBECC. 2019;24(1):22-30. https://doi.org/10.5327/10.5327/Z1414-4425201900010006 DOI: https://doi.org/10.5327/10.5327/Z1414-4425201900010006
8. Gama CS, Backman C, Oliveira AC. Impacto do uso do checklist cirúrgico e completude em complicações e mortalidade em cirurgias colorretais de urgência. Rev Col Bras Cir. 2022;48:e20213031. https://doi.org/10.1590/0100-6991e-20213031 DOI: https://doi.org/10.1590/0100-6991e-20213031
9. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AHS, Patchen Dellinger E, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-9. https://doi.org/10.1056/NEJMsa0810119 DOI: https://doi.org/10.1056/NEJMsa0810119
10. Röhsig V, Maestri RN, Mutlaq MFP, Souza AB, Seabra A, Faria ER, et al. Quality improvement strategy to enhance compliance with the World Health Organization Surgical Safety Checklist in a large hospital: Quality improvement study. Ann Med Surg (Lond). 2020 May 11:55:19-23. https://doi.org/10.1016/j.amsu.2020.04.027 DOI: https://doi.org/10.1016/j.amsu.2020.04.027
11. Silva PHA, Conde MBC, Martinasso PF, Maltempi RP, Jacón JC. Safe surgery: analysis of physicians’ adherence to protocols, and its potential impact on patient safety. Rev Col Bras Cir. 2020;47:e20202429. https://doi.org/10.1590/0100-6991e-20202429 DOI: https://doi.org/10.1590/0100-6991e-20202429
12. Spencer EA, Mahtani K. Hawthorne effect. In: Catalogue Of Bias; 2017.
13. Barros ACS, Pereira LC, Cavalcante RM, Nascimento LMO, Lopes EM. Use of the Surgical Safety Checklist in a maternity teaching hospital in the state of Ceará, Brazil. Rev SOBECC. 2023;28:E2328902. https://doi.org/10.5327/Z1414-4425202328902 DOI: https://doi.org/10.5327/Z1414-4425202328902
14. Gul F, Nazir M, Abbas K, Khan AA, Malick DS, Khan H, et al. Surgical safety checklist compliance: the clinical audit. Ann Med Surg (Lond). 2022;81:104397. https://doi.org/10.1016/j.amsu.2022.104397 DOI: https://doi.org/10.1016/j.amsu.2022.104397
15. Ohagwu IC, Seyi-Olajide JO, Ofuase A, Obi SI, Desalu I. Evaluation of compliance and utilization of the World Health Organization surgical safety checklist at the Lagos University Teaching Hospital: a cross-sectional study. Journal of Clinical Sciences. 2025;22(2):75-81. https://doi.org/10.4103/jcls.jcls_127_24 DOI: https://doi.org/10.4103/jcls.jcls_127_24
16. Schwendimann R, Blatter C, Lüthy M, Mohr G, Girard T, Batzer S, et al. Adherence to the WHO surgical safety checklist: an observational study in a Swiss academic center. Patient Saf Surg. 2019;13:14. https://doi.org/10.1186/s13037-019-0194-4 DOI: https://doi.org/10.1186/s13037-019-0194-4
17. Kamal MT, Seth US, Fattani B, Khan MTJ, Lattef S, Umer MF. Ensuring safe surgery: a closed-loop audit of the WHO Surgical Safety Checklist practices. Cureus. 2025;17(6):e85868. https://doi.org/10.7759/cureus.85868 DOI: https://doi.org/10.7759/cureus.85868
18. Associação Brasileira de Enfermeiros de Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização. Diretrizes de práticas em enfermagem perioperatória e processamento de produtos para saúde. 8a ed. São Paulo: SOBECC; 2021.
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Copyright (c) 2026 Cristina Rocha Amaral, Roberta Teixeira Prado, André Luiz Silva Alvim, Andréia Guerra Siman, Fabio da Costa Carbogim, Juliana Balbinot Reis Girondi, Isadora Caldeira Belini, Thiago Rodrigues dos Santos, Hérica Silva Dutra , Luciane Ribeiro de Faria
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