WHO Surgical Checklist

Both the California Hospital Patient Safety Organization and the California Hospital Association consider the improvement of surgical safety as essential to public health and endorse the concept of the “WHO Surgical Safety Checklist.”

The checklist reduces the chance of overlooking important information at three points during the patient’s care: at check-in, at the time-out, and at the end of the case. The majority of the activities on the checklist are already implemented in most USA hospitals, and most already have checklists for a portion of the patient’s care (particularly check-in), so this should not represent a major change in practice patterns, but would add some rigor to the critical phases, particularly at the end of the case. Certain aspects of the checklist are intended to improve team communication. A recent world-wide trial in eight very different hospitals exhibited significant reductions in morbidity and mortality in many of the institutions.

World-wide, about 234,000,000 major operations are performed every year. From those procedures, over 7,000,000 people experience disabling complications, and more than 1,000,000 die.

The WHO Safe Surgery Saves Lives site includes copies of the checklist, an implementation manual, and tools for training and implementation.

The Checklist, a New Yorker article by Atul Gawande, describes the case for checklists in making complex tasks safer.

The Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery addresses and augments many of the areas covered by the first two stages of the WHO checklist (check-in and time-out). The Joint Commission supports the use of the WHO Surgical Safety Checklist, but, in and of itself the WHO Checklist does not completely address the standards addressed by the Universal Protocol. To assist hospitals, the Hospital Association of Southern California (HASC) researched and developed a template Universal Protocol policy. Additionally, The Joint Commission has posted Universal Protocol FAQs (look for “Universal Protocol” near the bottom of the page.)