# Improving Compliance With the Surgical Safety Checklist: A Quality Improvement Project at Almanagil Teaching Hospital, Sudan

## TL;DR

This study improved compliance with surgical safety checklists in a Sudanese hospital through training and standardized tools.

## Contribution

Demonstrates effective low-cost interventions to enhance surgical safety checklist adherence in low-resource settings.

## Key findings

- Compliance with pulse oximeter and allergy checks improved from 18% to 100% and 18% to 98%, respectively.
- Educational and structural interventions significantly enhanced documentation quality and team communication.
- Demographic documentation improved from 0% to 100% compliance after the intervention.

## Abstract

Background: The WHO Surgical Safety Checklist (SSC) is a globally recognized tool that reduces perioperative morbidity and mortality. However, adherence to SSC practices remains suboptimal in many low-resource settings.

Purpose: This project aimed to assess and improve compliance with the WHO SSC and operative documentation standards at Al Managil Teaching Hospital, Sudan.

Methods: A two-cycle quality improvement audit was conducted in July 2025. In the first cycle, 50 randomly selected operative notes were reviewed for SSC compliance. Interventions included staff training, standard documentation templates, visual reminders, and regular feedback. Another 50 randomly selected postoperative notes were reassessed after implementation. Data were analyzed using chi-square and Fisher’s exact tests, with p < 0.05 considered significant.

Results: Compliance improved across nearly all SSC domains. Pulse oximeter checks increased from 9 (18%) to 50 (100%), anesthesia machine and medication checks from 10 (20%) to 50 (100%), and allergy checks from 9 (18%) to 49 (98%) (all p < 0.001). Before incision, equipment issue documentation rose from four (8%) to 50 (100%), team introductions from 11 (22%) to 50 (100%), and timely antibiotic prophylaxis from 42 (84%) to 50 (100%) (p = 0.01). Demographic documentation (gender, unit, address) improved from 0 (0%) to 50 (100%). Only surgical site marking (from 54% to 62%) and risk checks (from 90% to 98%) showed a non-significant change.

Conclusion: Educational and structural interventions, including standardized templates and feedback, significantly enhanced SSC adherence and documentation quality. The project demonstrates that low-cost, sustainable quality improvement measures can foster a culture of surgical safety in resource-limited hospitals.