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
