WHO's checklist for surgical teams will make operations safer

Jun 25 2008

The World Health Organization (WHO) has launched a new safety checklist for surgical teams to use in operating theatres.

The checklist is part of a major drive to make surgery safer around the world and aims to reduce the risks of complications and deaths as a result of major surgery.

Dr. Margaret Chan, the Director-General of WHO says preventable surgical injuries and deaths are a growing concern and research suggests that half of the complications resulting from major surgery may be preventable.

Dr. Chan says major surgery occurs at a rate of 234 million medical procedures per year, one for every 25 people, and using a checklist is the best way to reduce surgical errors and improve patient safety.

According to the WHO studies have shown that in industrial nations, major complications are reported in between 3 and 16 percent of surgical procedures.

The WHO report says research suggests that in developing countries there is a death rate of 5 to 10 percent during major surgery while mortality rates from general anesthesia alone is reported to be as high as 1 in 150 in parts of sub-Saharan Africa.

Dr. Atul Gawande, a surgeon and Harvard University professor says despite major improvements in surgical operations over the last decades, the quality and safety of surgical care has been dismayingly variable in every part of the world.

The WHO surgical safety checklist, which was developed under the leadership of Dr. Gawande, identifies a set of surgical safety standards that can be applied in all countries and health settings; it involved more than 200 medical organizations from around the world, including the health ministries of a number of countries.

The preliminary results from trials in eight pilot sites involving 1,000 patients worldwide show that the checklist has almost doubled the likelihood that patients will receive proven standards of surgical care.

The checklist has increased the rate of adherence to these standards from 36% to 68% and in some hospitals to almost 100%, resulting in substantial reductions in complications and deaths in the 1000 patients.

The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: before the induction of anaesthesia ("sign in"), before the incision of the skin ("time out") and before the patient leaves the operating room ("sign out").

In each phase, a checklist coordinator must confirm that the surgical team has completed the listed tasks before it proceeds with the operation.

The "sign in" phase, guarantees the coordinator has checked whether the surgical site on the patient's body was properly marked and whether the patient's known allergies were checked.

The "sign out" phase, guarantees instruments, sponges and needles have been counted to check that none of these is accidentally left behind in the patient's body.

The checklist will be finalized by the end of 2008 once the evaluation of the eight pilot studies is complete.