Compliance of General Surgeons with Safe Surgery in a General Navy Hospital, Alexandria, Egypt

Background: Surgical care is an integral part of health care throughout the world; and is gaining attention from the public health community worldwide. Objectives: This study was conducted to assess compliance and attitudes of the surgeons in the General Navy Hospital toward safe surgery. Methods: Fifty-five general surgical operations, performed in the 3 main operation rooms of the Anesthesia and Operations Department of study hospital were observed to assess the compliance of the operating 11 general surgeons to the WHO safe surgery checklist starting from 15 March 2010 and for three weeks.  Five observations were done for each surgeon. WHO checklist divides the operation into three phases namely sign in, time out and sign out, each corresponding to a specific time period in the normal flow of a procedure. All safety practices and steps were weighted equally such that a team was given 1 point for compliance with a practice or process and 0 point for noncompliance and scores could range from 0% to 100%. In order to assess how the safe surgery checklist was perceived, the same 11 general surgeons were interviewed with a structured questionnaire. Results: The least aggregate surgeons' compliance was in completing the safety practices comprising 'time out' phase; 56.4% (31 times out of the 55 surgeries). The highest aggregate surgeons' compliance was in completing the safety practices comprising 'sign in' phase was 65.5% (36 times out of the 55 surgeries). While, the aggregate compliance score of the 'sign out' phase was 67.3% (37 times out of the 55 surgeries), and that the overall aggregate compliance score for completing the 19 safety practices comprising the safe surgery checklist was 52.7% (29 surgeries out of the 55 surgeries).Regarding surgeons' attitude to safety practices items, none of the items was rated to be definitely ‘of no importance. Conclusion and Recommendations: Hospitals should consider implementing operating room briefings as a strategy to improve operating room efficiency and clinical and economic outcomes in surgical patients. Surgeons must be committed to the common goals of patient safety to ensure safe surgery.