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Development and validation of the SURgical PAtient Safety System (SURPASS) checklist
  1. E N de Vries1,
  2. M W Hollmann2,
  3. S M Smorenburg3,
  4. D J Gouma1,
  5. M A Boermeester1
  1. 1
    Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  2. 2
    Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands
  3. 3
    Department of Patient Safety, Academic Medical Center, Amsterdam, The Netherlands
  1. Dr M A Boermeester, Department of Surgery, Academic Medical Center, Meibergdreef 9, G4-132.1, 1105 AZ Amsterdam, The Netherlands; m.a.boermeester{at}


Introduction: A large number of preventable adverse events are encountered during hospital admission and in particular around surgical procedures. Checklists may well be effective in surgery to prevent errors and adverse events. We developed, validated and evaluated a SURgical PAtient Safety System (SURPASS) checklist.

Methods: A prototype checklist was constructed based on literature on surgical errors and adverse events, and on human-factors literature. The items on the theory-based checklist were validated by comparison with process deviations (safety risk events) during real-time observation of the surgical pathway. Subsequently, the usability of the checklist was evaluated in daily clinical practice.

Results: The multidisciplinary SURPASS checklist accompanies the patient during each step of the surgical pathway and is completed by different members of the team. During 171 high-risk surgical procedures, 593 process deviations were observed. Of the deviations suitable for coverage by a checklist, 96% corresponded to an item on the checklist. Users were generally positive about the checklist, but a number of logistic improvements were suggested.

Conclusion: The SURPASS checklist covers the vast majority of process deviations suitable for checklist assessment and can be applied in clinical practice relatively simply. SURPASS is the first validated patient safety checklist for the entire surgical pathway.

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  • Competing interests: None.

  • Funding: This research was funded by the Dutch Organization for Health Research and Development (ZonMw), The Hague, The Netherlands. Patient Safety Program, grant no. 8120.0007.

  • Patient consent: Obtained.