Safe surgery checklist impact trumpeted after decade of use

Over the past decade the Surgical Safety Checklist has played a key role in boosting communication and teamwork between surgeons, nurses and anaesthetists, helping ensure key safety checks are carried out before, during and after operations.

“It was a privilege to work with some of the country’s leading clinicians to develop this checklist”

Pauline Philip

Launched by the World Health Organization (WHO) in June 2008 – with significant input from UK clinicians – it was mandated for use in the NHS in January 2009 and is now standard procedure across the UK and in many other countries.

A wide range of studies and evaluations since 2008 have show the simple 19-item tool – modelled on the pre-flight checks undertaken by airline pilots – has reduced the rate of deaths and surgical complications by as much as a third in settings where it is used.

The checklist has also been credited with helping change the culture in operating theatres by placing an emphasis on listening to all members of the surgical team and valuing their contribution.

Other benefits from using the tool include cost savings and similar checklists are now in use in other clinical areas, including maternity, emergency and intensive care departments.

Pauline Philip, a nurse by background and currently national director for emergency and elective care for the NHS in England, led the development of the checklist when she was director for patient safety at WHO.

She highlighted the key role played by UK doctors and nurses in developing and testing the tool.

“The safety of patients should always be the number one priority for the NHS and for any health system around the world,” she said.

“It was a privilege to work with some of the country’s leading clinicians to develop this checklist to support safety in operating theatres around the world and a source of pride that the NHS led the world in piloting and adopting it,” she added.

Between October 2007 and September 2008, the effect of the checklist was studied in eight hospitals in eight cities. These included St Mary’s Hospital in Paddington, where the local lead was high profile surgeon Lord Ara Darzi, who also served as a government health minister.

 Ara Darzi

Ara Darzi masthead

Ara Darzi

Speaking at a celebration event organised by the Royal Society of Medicine and international safe surgery organisation Lifebox, Lord Darzi said the tool had contributed to wider improvements in patient safety.

“Ten years on from the introduction of the WHO Surgical Safety Checklist we have seen considerable improvements in the safety of patients undergoing surgery,” he said.

The impact of this pivotal innovation extends well beyond the surgical domain, prompting positive changes in the wider global patient safety movement,” said Lord Darzi.

The checklist ensures key questions are asked and safety checks made at three crucial points during an operation – before anaesthesia, before the skin incision and before the patient leaves theatre.

Theatre nurses have a pivotal role – alongside anaesthetists and surgeons – in working through the steps, designed to address serious and avoidable surgical complications.

These include basics such as confirming the patient’s identity, the type of procedure, site of surgery, instrument and equipment checks and discussion of any concerns.

The checklist also ensures all team members have introduced themselves by name and role before an operation gets under way.

“Countless harmful incidents have been avoided and it has helped to create a safety first culture on the NHS”

Derek Alderson

Its launch in 2008 was supported by many leading health organisations including the Royal College of Nursing and professional bodies for surgeons, anaesthetists and obstetricians.

Professor Derek Alderson, president of the Royal College of Surgeons, said the checklist showed that even simple innovations could have a profound impact on patient safety.

“Since its introduction, countless harmful incidents have been avoided and it has helped to create a safety first culture on the NHS. There is no excuse for surgical teams not to use it,” he said.

“Over the next decade it will be vital to help spread its adoption in other parts of the world. Once again, surgery in the NHS will act as a global role model,” he added.