Adherence to the WHO surgical safety checklist at Tibebe Ghion Specialized Hospital, Ethiopia: a prospective observational study

Abstract

BACKGROUND: The WHO Surgical Safety Checklist (SSC) is a globally recognized 19-item tool designed to improve team communication and reduce perioperative complications and mortality. Despite its proven efficacy in promoting safety by helping clinicians adhere to evidence-based best practice, its global compliance varies. Consequently, this study aims to assess the adherence to the WHO surgical safety checklist at Tibebe Ghione Specialized Hospital, Bahir Dar, Ethiopia. METHODOLOGY: Following ethical approval, a hospital-based prospective observational study was conducted on 213 surgeries performed at Tibebe Ghion Specialized Hospital from November- December, 2025. All patients who underwent elective surgery under anesthesia at TGSH during the study period were included. The WHO Surgical Safety Checklist was transformed into a structured Yes/No observational instrument and implemented through direct observation and chart review using a Kobo Toolbox-based questionnaire. Compliance with the three checklist phases (Sign In, Time Out, and Sign Out) was analyzed using the IBM SPSS Statistics for Windows, Version 26.0. RESULTS: A total of 213 surgical procedures were assessed using the Surgical Safety Checklist. The overall performance level across all checklist standards was 92.2%. The highest compliance was during the Sign-In and Time-Out phases, ranging from 89.7% to 99.5%. The lowest adherence was during the Sign Out phase, with adherence for specimen labeling, equipment problem reporting, and recovery management discussion was 75.1%, 76.5%, and 77.0%, respectively. CONCLUSION AND RECOMMENDATION: Overall compliance with the WHO Surgical Safety Checklist was high, particularly during the Sign-In and Time-Out phases. Critical safety practices, including patient verification, anesthesia checks, team communication, and timely antibiotic administration, were consistently performed. In contrast, adherence during the Sign Out phase was comparatively lower, especially for postoperative planning, specimen labeling, and equipment-related checks. These findings highlight the need for targeted interventions to improve Sign Out compliance and further strengthen overall surgical safety and quality of care.