Barreiras e facilitadores relacionados a aplicação do checklist da cirurgia segura

Abstract

The objective was to investigate the main barriers and facilitators for the implementation of the Safe Surgery Checklist in the Operating Room. To this end, a systematic review of the literature was carried out in the PubMed, VHL, Embase, Scopus, and Web of Science databases. The descriptors used included Communication Barriers, Patient Safety, Checklist, and Surgical Procedures. The search strategy was qualified and evaluated based on the Peer Review of Electronic Search Strategies tool. After selecting the studies, information was extracted on methodological characteristics, sample size, sociodemographic data of the participants, in addition to the barriers and facilitators reported. The data were submitted to meta-analysis to estimate prevalence, with calculation of 95% confidence intervals. Of the 43 studies initially identified, a subset was included in the meta-analyses according to eligibility criteria. The results indicate that 22% (95% CI: 12%–33%) of health professionals consider the checklist a time-consuming activity or a waste of time. In another outcome, 44% (95% CI: 28%–61%) of participants reported resistance to implementation, lack of support from staff—especially surgeons—or disbelief in the benefits of the checklist. In addition, 14% (95% CI: 3%–32%) pointed out the SSC as redundant or unnecessary, as they understood that it duplicates steps already performed in the routine. In all analyses, high heterogeneity was identified among the included studies, which highlights the diversity of institutional and cultural contexts involved. Despite the advances in promoting a safety culture, the implementation of the surgical checklist still faces relevant challenges. Structural barriers, negative attitudes of professionals and perception of overload are factors that directly impact adherence. Permanent education strategies, multiprofessional involvement and adaptation of the tool to the local reality are fundamental for its effectiveness.