Aplicação do checklist de cirurgia segura em voz alta: análise crítica da prática

Abstract

Surgical treatment is an essential therapeutic modality in healthcare, incorporating technological advances that provide cures for many diseases while reducing disabilities and mortality risks. In the context of patient safety, the Safe Surgery Checklist (SSC) was developed by the World Health Organization (WHO) as a tool with the potential to enhance safety in surgical care. However, during the implementation and use of the SSC in accordance with WHO recommendations which include verbal confirmation, various operational and communication challenges may compromise its effectiveness in reducing adverse events among surgical patients. This study aimed to analyze the compliance with WHO recommendations regarding the application of the surgical checklist in operating rooms, with particular attention to the verbal confirmation of safety items. This was a cross-sectional descriptive study with a quantitative approach, conducted in the surgical center of a public teaching hospital located in the Zona da Mata region of Minas Gerais, Brazil. The study population included surgical procedures from various specialties performed between April and August 2025. The sample size was determined based on the hospital’s average monthly number of surgeries and national adherence rates to the SSC, using convenience sampling. A total of 193 surgical procedures were directly observed in real time for checklist application, followed by verification of documentation in the patients’ medical records. Data were analyzed using Stata v.15 software. Descriptive statistics were presented as absolute and relative frequencies, and the McNemar’s chi- square test was used to compare proportions between verbal confirmation and recorded documentation, adopting a 5% significance level. SSC items were considered compliant when both verbal confirmation and proper documentation were observed. The results revealed statistically significant differences (p < 0.05) between verbal confirmation and recorded documentation across all checklist items and in all three surgical phases. Overall, a low level of compliance was observed, with a progressive decline in adherence throughout the surgical process. Verbal confirmation rates were notably lower than documented records, indicating that the checklist has often been used as a bureaucratic formality rather than as an active communication and risk mitigation tool. In conclusion, although the surgical checklist has been formally implemented in institutional routines and documentation is frequently completed, verbal confirmation remains limited, falling short of WHO recommendations for effective use of the tool. These findings highlight the need to strengthen the patient safety culture, particularly through strategies to improve adherence to verbal confirmation as a key safety practice in the surgical environment.