WHO launches checklist for safer surgery
7 July 2008
The World Health Organization (WHO) has launched a new safety
checklist for surgical teams to use in operating theatres, as part of a
major drive to make surgery safer around the world.
Preventable surgical injuries and deaths are a growing concern," said
Dr Margaret Chan, Director-General of WHO. "Using the checklist is the
best way to reduce surgical errors and improve patient safety."
With major surgery now occurring at a rate of 234 million procedures
per year — one for every 25 people — and studies indicating that a
significant percentage result in preventable complications and deaths,
Several studies have shown that in industrial countries major
complications occur in 3% to 16% of inpatient surgical procedures, and
permanent disability or death rates are about 0.4% to 0.8%.
In developing countries, studies suggest death rates of 5% to 10%
during major operations. Mortality from general anaesthesia alone is
reported to be as high as one in 150 in parts of sub-Saharan Africa.
Infections and other postoperative complications are also a serious
concern around the world. These studies suggest that about half of these
complications may be preventable.
"Surgical care has been an essential component of health systems
worldwide for more than a century," said Dr Atul Gawande, a surgeon and
professor at the Harvard School of Public Health. "Although there have
been major improvements over the last few decades, the quality and
safety of surgical care has been dismayingly variable in every part of
the world. The Safe Surgery Saves Lives initiative aims to change this
by raising the standards that patients anywhere can expect."
The Safe Surgery Saves Lives initiative is a collaborative effort led
by the Harvard School of Public Health. Two hundred surgery,
anaesthesia, nursing, and patient societies endorsed the introduction of
safety checklists in surgery and three countries, the United Kingdom,
Jordan and Ireland, pledged to introduce the checklist in all their
The WHO surgical safety checklist, developed under the leadership of
Dr Gawande, identifies a set of surgical safety standards that can be
applied in all countries and health settings.
Preliminary results from a thousand patients in eight pilot sites
worldwide indicate that the checklist has nearly doubled the likelihood
that patients will receive proven standards of surgical care.
Use of the checklist in pilot sites has increased the rate of
adherence to these standards from 36% to 68% and in some hospitals to
almost 100%. This has resulted in substantial reductions in
complications and deaths in the 1000 patients. Final results on the
impact of the checklist are expected in the next few months.
The pilot sites are at:
- Auckland City Hospital, New Zealand;
- St Mary’s Hospital, London;
- St Francis Designated District Hospital, Ifakara, United
Republic of Tanzania;
- University of Washington Medical Centre, Seattle, USA;
- University Health Network, Toronto, Canada;
- Prince Hamzah Hospital, Amman, Jordan;
- Philippines General Hospital, Manila, Philippines; and
- St Stephen’s Hospital, New Delhi, India.
The checklist identifies three phases of an operation, each
corresponding to a specific period in the normal flow of work: before
the induction of anaesthesia ('sign in'), before the incision of the
skin ('time out') and before the patient leaves the operating room
('sign out'). In each phase, a checklist co-ordinator must confirm that
the surgery team has completed the listed tasks before it proceeds with
For example, during the sign-in phase, the co-ordinator should check
whether the surgical site on the patient's body was properly marked and
whether the patient's known allergies were checked. During the sign-out
phase, instruments, sponges and needles should be counted to check that
none of these is accidentally left behind in the patient's body.
The checklist will be finalised for dissemination by the end of 2008
once the evaluation of the eight pilot studies is complete.
The World Health Organization Safe Surgery website
The WHO Emergency and Essential Surgical Care website