Difficulties in implementing a surgical check list in operating theatres

Objective: To assess the level of implementation and the factors associated with the compliance to the surgical check list (SCL) proposed by the WHO, in surgery departments in public hospitals in the Murcia Region of Spain. Methodology: A retrospective cross-sectional study was conducted using a random, non-proportional, and stratified sample in each hospital. The sample size was established as 10 cases per centre, with a total of 90 surgical operations. The data analysis included the percentage of compliance of the variables of interest (presence of an SCL and the compliance to it, complete, by sections and by items) at regional level, according to hospital, hospital groups, depending on the size; the type of anaesthesia (local, regional or general); the work shift (morning or afternoon); as well as the age and sex of the surgery patients. Results: The check list was found in the medical records in 75 cases (83.33%; confidence interval [CI]: 78.7% - 87.5%), and complied with in full in 25 cases (27.8%; 95% CI: 18.5% - 37.0%). The percentage of items complied with was 70.1% (95% CI: 67.9%-72.2%). The percentage compliance varied by hospital, from 35.8% to 98.9%. The logistic regression analysis showed significance in the variables such as, the size of the hospital (the list was more likely to be complied with in small and medium hospitals) and operations with local anaesthetic as a negative predictive factor of compliance. Conclusions: The SCL is used, but is not always complied with, and not homogeneously in all its sections. There is also significant variation between the public hospitals in the Murcia Region of Spain. (C) 2011 AEC. Published by Elsevier Espana, S.L. All rights reserved.