Implementation of the World Health Organization Surgical Safety Checklist and pulse oximetry in a resource-limited setting

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• 作者：Alvin C. Kwok ; MD ; MPH ; Luke M. Funk ; MD ; MPH ; Ruslan Baltaga ; MD ; Stuart R. Lipsitz ; ScD ; Alan F. Merry ; MB ; ChB ; FANZCA ; Gerald Dziekan ; MD ; William R. Berry ; MD ; MPH ; Atul A. Gawande ; MD ; MPH ; FACS
• 刊名：Journal of the American College of Surgeons
• 出版年：2011
• 出版时间：September, 2011
• 年：2011
• 卷：213
• 期：3_supp_S
• 页码：S113
• 全文大小：1K

文摘

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Introduction

The WHO Surgical Safety Checklist has been shown to reduce post-surgical mortality and morbidity. However, one essential component of the Checklist - pulse oximetry - is not available in much of the developing world. We sought to measure the impact of the Checklist, together with oximetry, in a resource-limited setting.

Methods

Eight months of pre and post-implementation data regarding intra-operative processes and post-operative complications were collected at a tertiary care hospital in Chisinau, Moldova. A one month period was used for implementation of the Checklist and oximetry. Oximeters were supplied for all 22 operating tables. Rates of hypoxemia (Spo2 <90 % ) were measured by each oximeter. Chi-squared tests were used to compare pre/post process measures. Logistic regression was used to adjust morbidity and mortality for age, gender, urgency of case and mode of anesthesia.

Results

3,565 operations (2,144 pre and 1,421 post) were included. After Checklist implementation, measures of intra-operative communication improved by over six-fold (p<0.0001). Percent of patients receiving prophylactic antibiotics increased from 27.4 to 79.8 % (p<0.0001). The adjusted morbidity rate decreased from 24.3 % to 8.9 % (p<0.0001). A trend towards improvement in adjusted mortality was observed (3.7 % vs. 2.6 % ; p=0.09). The rate of intra-operative hypoxemia decreased from 12.9 to 7.7 episodes per 100 hours of oximetry (p<0.0004) from month 1 to month 3 following implementation.

Conclusions

Implementation of the Checklist, together with oximetry, can reduce post-surgical morbidity and mortality, and can decrease hypoxemia rates in a resource-limited setting. Universal implementation of both could have a significant impact on surgical care throughout the world.