Introduction: Surgical safety is a critical global health concern, particularly in low- and middle-income countries where preventable perioperative errors remain a leading cause of morbidity and mortality. The World Health Organization (WHO) Surgical Safety Checklist (SSC) is an evidence-based intervention designed to enhance surgical outcomes through improved communication and team coordination. This study aimed to (1) assess the extent of SSC utilization at the Princess Christian Maternity Hospital (PCMH), Freetown, Sierra Leone, and (2) identify key barriers affecting its effective implementation.
Methods: A descriptive cross-sectional qualitative study was conducted over a five-month period (February to May 2025) at PCMH. Data collection comprised two components.
· Direct observation of 80 surgical procedures using the WHO SSC to assess implementation fidelity.
· Structured questionnaires administered to surgical team members including medical doctors, perioperative nurses, nurse anesthetic technicians, and Surgical Assistant Community Health Officers (SACHOs) to identify perceived barriers to SSC use.
Results: The SSC was present in 100% (n=80) of observed surgical cases; however, full compliance with all checklist items was notably low. Only patient identity verification and consent confirmation were consistently performed across all cases. Key safety elements such as surgical site marking (16.3%), team introductions (2.5%), review of critical steps (3.8%), and postoperative equipment checks (1.3%) were frequently omitted. Compliance with anesthesia and allergy-related checks exceeded 95%. Questionnaire responses identified major barriers to effective checklist use, including insufficient training (87%), lack of assertiveness among team members (86%), time constraints (81%), the procedural burden of obtaining signatures (79%), and the unavailability of a digital checklist (59%).
Conclusion: Although the WHO SSC was universally adopted at PCMH, its implementation was inconsistent and often incomplete, undermining its intended impact on patient safety. Systemic and cultural barriers including gaps in training, workflow inefficiencies, and hierarchical communication dynamics contribute significantly to suboptimal checklist utilization. Strengthening training programs, promoting assertive communication, integrating digital tools, and fostering a robust safety culture are essential steps toward optimizing SSC implementation and improving surgical outcomes in resource-limited settings.
International Journal of Advanced Research in Medicine
