The WHO surgical checklist

doi:10.1016/j.bpa.2011.02.002

Best Practice & Research Clinical Anaesthesiology

Volume 25, Issue 2, June 2011, Pages 161-168

https://doi.org/10.1016/j.bpa.2011.02.002 Get rights and content

Following the overwhelming evidence of adverse events in hospital practice, the World Health Organization (WHO)'s World Alliance for Patient Safety has launched the ‘Safe Surgery Saves Lives’ campaign, which has developed a surgical safety checklist aimed to improve patient safety. The implementation of this checklist has met with mixed reactions in different institutions. Many countries have still not adopted its use. In this article, a brief review is presented regarding the role of the WHO checklist, barriers to its implementation and strategies for successful adoption.

Section snippets

Checklists to improve safety

In military, checklists along with briefing and debriefing sessions have been instrumental in enhancing the safety culture. “The act of opening a project checklist speaks to the individual and the team, sending the message that there is a deliberate intent to be disciplined. This intent is often a self-encouraging step that results in improved performance. This occurs in addition to eliminating the obvious errors of omission for which the project checklist is designed.”⁸

In the aviation

Barriers to implementation of the checklist

Despite the evidence that the checklist reduces surgical morbidity and mortality, and political will to support its implementation, at present, the adoption of the WHO checklist in clinical practice has met with mixed reactions all over the world. Some of the barriers and challenges in implementing the checklist are summarised in the following.¹³

Implementing WHO Checklist Successfully

There is no doubt that correct and robust implementation of the checklist is central to full realisation of its benefits. The real challenges to the implementation of the checklist are primarily cultural. Therefore, it is important to realise that the implementation will require an adaptive solution. Expecting that a straightforward technical solution (checklists) will solve an adaptive (cultural) problem is too simplistic. Experience from Michigan provides excellent evidence that, in addition

Conflict of interest statement

The author is Chairman of Safe Anaesthesia Liaison Group at the Royal College of Anaesthetists, UK. He also represented Anaesthesia in the expert reference group, which was responsible for introduction of the WHO checklist in the UK.

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The evidence is assimilated with the opinions of the authors to provide recommendations. Best practice pathways for patient care in the pre-operative, intra-operative, and post-operative periods are described, including the identification and management of residual stones. Key complications (sepsis and stent issues) that are relevant for any endourological procedure are then be discussed. Operation-specific considerations are then explored. Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury. The role of endoscopic combined intrarenal surgery in this regard is discussed. Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury. The role of anaesthetic assessment is discussed. The importance of specific comorbidities on each step of the pathway is highlighted as examples.
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The intention of this paper is not to establish definitively whether the quantitatively identified themes; including a lack of training and engagement with human factors explains the increased presence of intraoperative ‘Never Events’. However, these themes, when subjected to methodological triangulation with the current literature, do appear consistent, and therefore provide an exploratory approach to inform research intended to improve safety in the operating theatre by informing policy and its application to safe practice ultimately towards quality improvements.
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This literature review will discuss the concept of QoR, the development thereof, and explore the different assessments of QoR. Special attention is paid to the Quality of Recovery 40 (QoR-40) and the Quality of Recovery 15 (QoR-15) assessment tools, with further attention to development, composition, validation, and subsequent usage of the QoR-15. Furthermore, factors that have been found to influence QoR and the importance of measuring QoR will be discussed.
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It is in the box! Improving the usability and benefits of surgical safety checklists – A feasibility study
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Up to 50% of preventable hospital medical errors occur in or after visiting an operating theater in the United States. To address this issue, hospitals use a Surgical Safety Checklist (SSC), which can reduce complications and mortality rates when used systematically. To execute it, surgeons read aloud from a poster hanging on a wall. However, studies report usability issues with posters and often surgeons execute the checklist from memory, which can reduce completion rates at the expense of patient safety. We present a novel approach to increase the SSC's usability in view of improving patient safety. Our DigitalChecklistBox displays the SSC directly on a patient's surgical drape and enables surgeons to navigate through the checklist using hand gestures. Evaluated with 10 surgeons, it increased the checklist elements' readability and navigation and brought additional functionalities to limit the number of missed elements.

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View full text

5The WHO surgical checklist

Section snippets

Checklists to improve safety

Barriers to implementation of the checklist

Implementing WHO Checklist Successfully

Conflict of interest statement

Joint Commission Journal on Quality and Patient Safety

Lancet

The incidence and nature of in-hospital adverse events: a systematic review

Quality and Safety in Health Care

To err is human

On error management: lessons from aviation

British Medical Journal

WHO's patient-safety checklist for surgery

Lancet

Checklists save lives

Bulletin of the World Health Organization

Safe surgery saves lives

WHO surgical safety checklist

Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR

Quality and Safety in Health Care

5
The WHO surgical checklist