Why You Need a Surgical Safety Checklist

June 11, 2014

To help ensure basic safety standards and improve patient care, the World Health Organization (WHO) prepared a surgical safety checklist in 2008 that, according to findings in more than 20 studies, has shown to dramatically improve patient outcomes when properly implemented.

One study indicated a decrease of 47% in perioperative mortality and a second study showed a decrease of 62%. One Connecticut hospital lowered its surgical infections by 75% after training staff to implement the checklist. The New England Journal of Medicine also found surgical teams who consistently use a surgical safety checklist such as the one below from WHO reported half the patient mortality rates and substantially lower complication instances as well.

Before Induction of Anesthesia

SIGN-IN

  • Has the patient confirmed his/her identity, site, procedure, and consent?
  • Is the site marked?
  • Is the anesthesia machine and medication check complete?
  • Is the pulse oximeter on the patient and functioning?
  • Does the patient have a:
    • Known allergy?
    • Difficult airway or aspiration risk?
    • Risk of >500ml blood loss (7ml/kg in children)?

Before Skin Incision

TIME-OUT

  • Confirm all team members have introduced themselves by name and role.
  • Confirm the patient’s name, procedure, and where the incision will be made.
  • Has antibiotic prophylaxis been given within the last 60 minutes?

Anticipated Critical Events

To Surgeon:

  • What are the critical or non-routine steps?
  • How long will the case take?
  • What is the anticipated blood loss?

To Anesthetist:

  • Are there any patient-specific concerns?

To Nursing Team:

  • Has sterility (including indicator results) been confirmed?
  • Are there equipment issues or any concerns?
  • Is essential imaging displayed?

Before Patient Leaves Operating Room

SIGN-OUT

  • Nurse verbally confirms with the team:
    • The name of the procedure recorded
    • That instrument, sponge and needle counts are correct (or not applicable)
    • How the specimen is labeled (including patient name)
  • Whether there are any equipment problems to be addressed
  • Surgeon, anesthesia professional and nurse review the key concerns for recovery and management of this patient