A systematic review of interventions Used to enhance compliance and implementation of the WHO Surgical Safety Checklist in adult surgery

This systematic review aimed to identify and synthesize the evidence for effectiveness of interventions on compliance of the WHO Surgical Safety Checklist (SSC) in adult surgery. Databases searched included CINAHL, MEDLINE, PsycINFO and Cochrane Central. Our review was limited to 24 peer-reviewed articles with quantitative (N=17), qualitative (N=4) and mixed methods design (N=3) published in English from 2008 to 2020. Intervention models were: 1) Modifying the ways of delivering the SSC; 2) Integrating or tailoring SSC to local contexts or existing practice; 3) Promoting clinician awareness and engagement; 4) Institutional policy management. Despite a lack of common outcome measures, all 17 quantitative studies and three mixed method studies found a significant intervention effect on SSC compliance. A few studies reported insignificant or negative changes in certain aspects with the interventions. Further studies must address compliance measures and outcomes in developing countries.