The alarming rate of surgical errors around the world was the impetus for the World Health Organization (WHO) to develop an incredibly effective yet simple solution - the WHO Surgical Safety Checklist. This straightforward 19-item checklist has been shown to dramatically reduce complications and deaths from surgery when implemented properly.
So what exactly is this life-saving tool, and why does it work so well? Read on to learn about the development, effectiveness, implementation, and evolving role of the WHO Safe Surgical Checklist.
A Response to the Global Surgical Safety Crisis
The creation of the WHO Surgical Safety Checklist was spurred by sobering statistics - rates of avoidable surgical harm remained unacceptably high worldwide. Studies estimate that major complications occur in 3-16% of inpatient surgical procedures globally. The death rate from major complications is around 0.4-0.8%, meaning nearly 1 million people die every year from preventable surgical harm. It was clear something had to be done.
In 2007, the WHO launched the Second Global Patient Safety Challenge, aiming to reduce surgical mortality and morbidity across nations. A panel of experts came together to develop a solution that was simple, scalable, and effective. The result was the Surgical Safety Checklist - a straightforward checklist to confirm that critical safety steps are completed for every surgical patient.
An Overview of This Powerful Tool
The WHO Surgical Safety Checklist is used at three critical junctures in care: before anesthesia is administered, immediately before incision, and before the patient leaves the operating room. It is a basic checklist with just 19 essential items that focus on improving team communication and consistency of care.
The checklist starts with confirming basics like patient identity, surgical site, procedure, and consent. It ensures the surgical site is marked and that prophylactic antibiotics are given. The team verbally reviews critical concerns like patient allergies, airway difficulties, and anticipated blood loss.
Before incision, the checklist focuses on preventing operative team mistakes. They confirm out loud that they have the right patient, procedure, and site. They review if antibiotic prophylaxis was given and if imaging results are displayed.
Finally, before the patient leaves the OR, the team confirms if specimens are correctly labeled, if equipment issues need addressing, and if concerns exist for recovery. This provides a final safety check before the handoff to post-op care.
Dramatic Evidence for Checklist Effectiveness
Multiple large-scale studies have shown that use of the WHO Surgical Safety Checklist significantly improves outcomes. A 2009 study published in the New England Journal of Medicine found that implementing the checklist in 8 hospitals around the world reduced major complications by 36% and deaths by 47%.
Additional studies in the Netherlands, UK, and Canada have consistently shown a 30-40% reduction in complications and deaths when the checklist is used. Besides saving lives, it also reduces costs - one study found a USD $1.4 million reduction in costs from averted complications in one hospital over 3 months.
It’s clear that this simple checklist works - but why? First, it improves consistency of care by ensuring critical safety steps don’t get missed. Second, the verbal “timeouts” enhance teamwork and communication between the surgeon, anesthetist, nurses, and other operating room staff. This strengthens the safety culture.
Implementing the Checklist for Maximum Effectiveness
While the checklist itself is straightforward, implementing it effectively requires strategy and commitment. WHO acknowledges that successful introduction requires adaptation and consultation to ensure the checklist fits the local setting and surgical workflow. They published an implementation manual to aid hospitals in rollout.
First, hospitals need to secure buy-in from surgical leadership as well as frontline providers like surgeons, anesthetists, and nurses. All must be committed to using the checklist for it to work. Focusing on how it improves teamwork and communication helps secure support.
Training in the purpose and proper use of the checklist is critical - it should be seen as assisting providers versus simply oversight. During implementation, it’s important to solicit feedback from surgical staff to improve the rollout. Continuous training and auditing of checklist use ensures compliance.
When introduced thoughtfully with clinician input, the WHO Surgical Safety Checklist can transform surgical safety. But without proper implementation, even the best practices will fail. Engaging all surgical staff in the rollout is key to saving lives with this checklist.
An Evolving Role in the Quest for Harm-Free Surgery
The WHO Surgical Safety Checklist debuted in 2008 but its use has only grown, with many hospitals expanding it beyond the operating room. Pre-op checklists are being used to confirm consent, site marking, and medication reconciliation. Post-op checklists ensure critical steps like wound checks and venous thromboembolism prevention.
The Checklist has evolved from a simple safety tool to a way to help providers optimize their workflows. Surgeons are customizing it to include critical steps for specific procedures. It acts as a “preflight checklist” - allowing teams to run standard checks that mitigate errors.
In the digital age, hospitals are developing electronic versions of the checklist that integrate with the electronic medical record. This may improve compliance, efficiency, and analytics around checklist use. However, the “verbal timeouts” remain critical for team communication.
The Checklist also provides documentation that the care team completed essential safety processes for every surgical patient. This allows hospitals to demonstrate their commitment to harm prevention - an important part of accreditation. The WHO Checklist has become a symbol of a safety-first culture.
An Indispensable Solution for Safer Care
The WHO Surgical Safety Checklist is an indispensable tool in the global effort to reduce preventable harm. This humble checklist has demonstrated its profound ability to save lives and reduce complications across hospitals worldwide. By improving consistency, communication, and documentation, it transforms safety culture.
But the checklist is only as effective as its implementation. With local adaptation, training, and buy-in from all surgical staff, it can make an enormous difference in outcomes. As surgery continues to advance, so does the checklist - evolving to meet new challenges.
There is still work to be done in making surgery safer for every patient. But the WHO Safe Surgery Checklist stands as a proven, essential solution - one that every hospital across the globe should be using to reduce preventable surgical deaths. When implemented thoughtfully, this simple checklist has the power to save countless lives.