PATIENT SAFETY
Reported Versus Observed Surgical Safety Checklist Time-Out Adherence in the Hybrid OR
Published on
Feb 19, 2026
World Journal of Surgery
Nicholas Rennie, Gilles Soenens, Ida Meyns, Zara Legein, Peter Vlerick, Caroline Vanpeteghem, Bas Bruneel, Isabelle Van Herzeele
Overview
This publication examines real-world adherence to the World Health Organization (WHO) Surgical Safety Checklist (SSC) during the time-out phase of endovascular procedures performed in a hybrid operating room. Recognizing that endovascular surgery is high risk and that prior evidence on SSC effectiveness has been mixed, the authors conducted a single-center retrospective observational study using prospectively collected data from 212 procedures between May 2021 and December 2022. In addition to comparing paper and electronic checklists, the study leveraged video recordings from the OR Black Box and applied the Checklist Performance Observation for ImprovemeNT (CheckPOINT) tool to objectively assess checklist performance.
The study’s central aim was to compare reported checklist completion (as documented by the surgical team) with observed adherence (as assessed via video review), and to evaluate the utility of the CheckPOINT tool in capturing the quality of checklist execution. By combining structured observational scoring with video-based analysis, the authors sought to uncover potential discrepancies between documentation and actual team behavior in the operating room.
Results
Time-out was initiated in 87.7% of procedures, with reported completion averaging 95.5% of checklist items (median 15 items completed). However, direct video observation revealed a stark contrast: average observed completion was only 46.8%, with a median of seven items completed. Observed adherence was significantly lower than reported adherence for nearly all checklist items except “Patient Name.” Notably, more experienced surgeons were significantly less likely to initiate the time-out and less likely to complete it thoroughly. Furthermore, CheckPOINT scores for team engagement were significantly lower than scores for adherence, communication effectiveness, and attitude, suggesting that participation quality lagged behind surface-level compliance metrics.
Overall, the findings highlight a substantial gap between documented and actual SSC adherence in the hybrid OR. The authors conclude that video-based observation combined with structured assessment tools such as CheckPOINT can provide a more accurate understanding of checklist performance and may serve as a foundation for data-driven quality improvement initiatives in high-risk surgical environments.
Peer-reviewed Research
