Background: Compliance with the WHO surgical safety checklist potentially reduces preventable adverse events in surgery. However, compliance may be difficult to implement in Thailand. This study was conducted to examine the compliance with the WHO surgical safety checklist.

Methods: A descriptive study was conducted among 4,340 patients undergoing surgery at nine departments in a university hospital in Thailand from March to August 2008. The compliance rates were computed and presented in percentage.

Results: The highest compliance rate (91.4%) during the sign in period was the patients confirmed their identity, site, procedure, and consent. However, only 19.4% of the surgical sites were marked. In the time out period, surgical teams had introduced themselves by name and role in 79% of the operations, and in 95.7% of the cases the patient's name, the incision site, and the procedure had been confirmed. Antibiotic prophylaxis had been given within 60 minutes before incision in 71% of the cases. For 83% of the operations, the surgeons reviewed critical events while only 78.4% were reviewed by the anesthetists. The sterility had been confirmed by the operating room nurses for every patient (100%), and the essential imaging was displayed at a rate of 64.4%. In the sign out period, nurses correctly confirmed the name of the procedure verbally in 99.5% of the cases. Patients, instrument, sponge, and needle counts were completed and specimen was labeled in most cases, 96.8% and 97.6% respectively. Equipment related problems were found in 4.4% of the cases and 100% of them were addressed. The surgeon, anesthetist, and nurse reviewed the key concerns for recovery and management of the patient at the rate of 85.1%.

Conclusions: Our study suggested that the checklist could be implemented in a developing country. However, compliance with some items was extremely low, reflecting different work patterns and cultural norms. Additional education and enforcement of checklist use is needed to improve compliance.