10 years of checklists have improved surgical safety

Author: Ingrid Torjesen

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A checklist for surgical teams developed by the World Health Organization (WHO) and introduced within the NHS 10 years ago has saved countless lives and improved outcomes for patients, NHS England says.

The Surgical Safety Checklist is a simple tool designed to improve communication and teamwork by bringing together the surgeons, anaesthesia providers and nurses involved in care to confirm that critical safety measures are performed before, during and after an operation. It was launched by the WHO in June 2008, with substantial input from UK clinicians, and mandated for use in the NHS in January 2009.

The checklist is a simple 19-item tool which addresses serious and avoidable surgical complications, by ensuring that critical steps outlined in the guidelines are done in every surgery, every time, everywhere. It also serves as a critical communication tool for the operating theatre team.

The checklist’s three-pause point structure represents natural breaks in the surgical flow, and emphasises time points where changes can be made before it is too late. Each item within these pause points serves either to trigger a process check of a critical safety step, or prompt a discussion to ensure a common understanding of the patient’s specific history, the surgical plan, and any potential problems that could arise during the procedure.

Between October 2007 and September 2008, the effect of the checklist was studied in eight hospitals in eight cities, including St Mary’s Hospital in Paddington, where the local lead was former health minister Lord Ara Darzi. Those pilots found that use of the checklist reduced the rate of deaths and surgical complications by more than one-third across all eight pilot hospitals. The rate of major inpatient complications dropped from 11% to 7%, and the inpatient death rate following major operations fell from 1.5% to 0.8%.

Other benefits of the checklist include cost savings and improved communication between staff members. Similar checklists have now been introduced in a range of other clinical areas, including childbirth, emergency departments, and intensive care units.

Lord Darzi said: “10 years on from the introduction of the WHO Surgical Safety Checklist we have seen considerable improvements in the safety of patients undergoing surgery. The impact of this pivotal innovation extends well beyond the surgical domain, prompting positive changes in the wider global patient safety movement. We must not allow healthcare to become complacent – and in the coming decade, we need to adopt behavioural, digital and technological innovations, to ensure we fulfil our commitment to improving patient safety worldwide.”

Professor Derek Alderson, president of the Royal College of Surgeons said: “The WHO surgical safety checklist has demonstrated that even simple innovations can have profound patient safety benefits in healthcare. Since its introduction, countless harmful incidents have been avoided and it has helped to create a safety-first culture in the NHS. There is no excuse for surgical teams not to use it.

“Over the next decade it will be vital to help spread its adoption in other parts of the world.”
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