CHPSO joins CHA in support of WHO surgical checklist
Both the California Hospital Patient Safety Organization and the
California Hospital Association (CHA) consider the improvement of
surgical safety as essential to public health and endorse the
concept of the “WHO Surgical Safety Checklist.”
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.
Surgical care is complex and involves dozens of steps that must
be optimized for individual patients. In order to effectively
minimize unnecessary loss of life and serious complications,
operative teams have 10 basic and essential objectives in any
surgical case, which the WHO Safe Surgery Guidelines aim to
The team will operate on the correct patient at the correct
The team will use methods known to prevent harm from
anesthetic administration, while protecting the patient from
The team will recognize and effectively prepare for
life-threatening loss of airway or respiratory function.
The team will recognize and effectively prepare for risk of
high blood loss.
The team will avoid inducing any allergic or adverse drug
reaction known to be a significant risk for the patient.
The team will consistently use methods known to minimize risk
of surgical site infection.
The team will prevent inadvertent retention of instruments or
sponges in surgical wounds.
The team will secure and accurately identify all surgical
The team will effectively communicate and exchange critical
patient information for the safe conduct of the operation.
Hospitals and public health systems will establish routine
surveillance of surgical capacity, volume, and results.
Improved teamwork and communication is one of the main goals for
using a checklist. Many hospitals already implement most of the
items on the list but may not be reviewing them as a team. If
there is no designated point when these items are reviewed, they
may be verified most of the time, but not every time, reducing
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.
world-wide trial in eight very different hospitals exhibited
significant reductions in morbidity and mortality at many of the
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 Universal Protocol policy template.