Table 1. Original publications on the implementation of the WHO’s Surgical Safety Checklist and its effect on morbidity, mortality, and safety culture.
| Target criterion | Study | Study design | Sample size | Findings |
| Efficacy | Haynes 2009 (5) | Prospective longitudinal study | 842(908)*1/8*23733(3955)/8 | Reduction of mortality from 1.5% to 0.8% and of complication rate from 11% to 7% |
| Weiser 2010 (7) | Prospective longitudinal study | 1750/8 | Reduction of mortality from 3.7% to 1.4% and of complication rate from 18.4% to 11.7% | |
| Van Klei 2012 (8) | Retrospective cohort study | 25513/1 | Reduction of mortality, correlation with correct implementation | |
| Panesar 2011 (9) | Retrospective chart review | 133 | Potential prevention of 21.1% of all wrong-side errors | |
| Truran 2011 (10) | Prospective longitudinal study | 370/1 | Reduction of errors in thrombosis prophylaxis (6.9% to 2.1%) | |
| Safety culture | Haynes 2011 (1) | Retrospective data analysis | 281/1 | Reduction of complication rate is correlated with improvement in safety culture (r = 0.71) |
| Nilsson 2010 (11) | Staff questionnaire | 331/2 | 93% of persons surveyed thought that the time-out increases patient safety in the OR | |
| Helmio 2011 (12) | Longitudinal staff questionnaire | 288(412) | Communication in the OR rated more frequently as effective, both by anesthesiologists (79.2% vs. 86.9%) and by OR nurses (64.9% vs. 90.8%) | |
| Takala 2011 (13) | Longitudinal staff questionnaire | 901(847)/4 | Improved communication and awareness of safety-related information | |
| Calland 2011 (14) | Prospective randomized study | 20/1 | Behavior showing more consciousness of safety issues after introduction of the WHO checklist | |
| Practicalimplementation | Sivathasan 2010 (15) | Cross-sectional study, survey | 138/138 | Acquaintance with the WHO checklist in 99% of all hospitals surveyed, introduction in 66% |
| Conley 2011 (16) | Structured interviews | 10/5 | Implementation depends on the example set by leading physicians and their leadership style | |
| Paull 2009 (17) | Longitudinal observational study | 64/64 | Implementation depends on the example set by leading physicians (R = 0.34, p = 0.03) | |
| Gueguen 2011 (18) | Retrospective chart review and qualitative staff survey | 34(36)/2 | Hôpital Belle-Isle, Metz: 100% implementation, 70% completeUniversity Hospital, Nancy: 50% implementation, 20% complete Items raising concern in 15.2% and 32.4% of lists | |
| Paugham-Burtz 2011 (19) | Retrospective chart review Observation of implementation | 25/1 | Sign-in and time-out both 90% complete, sign-out 75% completeAdequate communication in only 4% of cases, no communication at all in 27% | |
| Vogts 2011 (20) | Observational study | 100/1 | Implementation rates: sign-in 99%, time-out 94%, sign-out 2% | |
| Fourcade 2011 (21) | Retrospective longitudinal chart review | 303(1299)/17 | Implementation (70% to 100%), completeness (20% bis 100%), and changes in these two values over one year (–21.25% to 17.5%, and –37.5% to 22.5%, respectively) vary widely among hospitals; items raising concern in 1.5% to 1.9% | |
| Rateau 2011 (22) | Retrospective analysis of electronic patient data | 40000/1 | Performance of operation despite presence of items raising concern in 2.1% of cases. | |
| Training | Sewell 2011 (23) | Prospective longitudinal chart review | 480(485)/1 | Training raises the frequency of implementation (from 7.9% to 96.9%). |
| Costs | Semel 2010 (24) | Cost calculation | – | Prevention of 5 serious complications neutralizes the cost of implementation of the WHO checklist at a complication rate of 3% |
| Acceptance among patients | Kearn 2011 (25) | Postoperative patient survey | 58/1 | Preoperative check does not make patients more worried (100%), but rather reassures them (97%) |
*1he numbers in parentheses indicate the sample size of the second group in longitudinal studies
*2 The number after the slash indicates the number of participating centers