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    WHO Surgery Safety Checklist Aims to Reduce Complications and Deaths

    By Jennifer Huddleston, staff writer     

    There are 234 million major surgery procedures performed each year, which equates to approximately one for every 25 people. [1] Of those, about 1 million patients die following major surgery. [2] To improve surgical safety worldwide, the World Health Organization (WHO) in June 2008 launched a new checklist of surgical safety standards for surgical teams to use worldwide and in all medical settings. [3]

    “Preventable surgeries and deaths are a growing concern,” said Dr. Margaret Chan, director-general of the WHO. “Using the checklist is the best way to reduce surgical errors and improve patient safety.”
    [4]

    The safety standards set forth in the checklist aim to increase anesthesia safety and decrease preventable infections and preventable complications from bleeding—the top three causes of death during surgery.
    [5]

    The checklist, printed on a 2-foot-by-3-foot laminated poster attached to an IV pole in the operating room,
    [6] consists of three phases: —“sign in,” “time out” and “sign out.” [7]

    The “sign in” stage occurs before anesthesia is administered.
    [8] The patient must confirm his or her identity before going into the operating room and, once inside, all members of the surgical team provide their names and roles in the procedure. [9] The “time out” phase happens before the initial incision is made and the “sign out” stage occurs before the patient leaves the operating room. During each phase, a checklist coordinator confirms that the surgery team has completed all listed tasks before moving to the next phase. [10]

    The use of the checklist in pilot site studies resulted in increased rates of adherence to the WHO standards from 36 percent to 68 percent—and up to 100 percent in some hospitals. The increased adherence to the standards translated to significant reductions in complications and deaths in the 1,000 patients included in the pilot studies.
    [11]

    The University of Washington Medical Center (UWMC), the only U.S. site involved in the WHO checklist worldwide pilot program, implemented the checklist in April 2008.
    [12]

    “Patients say to me, ‘You mean you haven’t already been doing this?’” said Dr. Patchen Dellinger, chief of surgery at UWMC.
    [13]

    Nurses at UWMC agree that the checklist ensures that everyone on the surgical team is completely focused on the patient. Nurse Debby Lunde said that going through the checklist provides a time for them to speak up if they have questions or concerns—something they couldn’t do before.
    [14]

    “Now we’re a true team instead of three separate groups playing on the same team,” said Jodi Bloom, RN at UWMC.
    [15]

    The seven other sites participating in the pilot program include:
    [16]

    • The University of Toronto in Toronto, Canada
    • St. Mary’s Hospital in London, United Kingdom
    • The University of Auckland in Auckland, New Zealand
    • St. Stephen’s Hospital in New Delhi, India
    • District Hospital in Ifakara, Tanzania
    • Philippine General Hospital in Manila, Philippines
    • Prince Hamza Hospital in Amman, Jordan

    Final results of the pilot site studies are expected to be released in coming months and the checklist released by the WHO in June will be finalized for distribution by the end of 2008. [17]


    [1] “New Checklist to Help Make Surgery Safer.” World Health Organization Press Release. June 25, 2008.
    [2] “Safety Checklist for Ops Launched.” BBC News. June 25, 2008.
    [3] “New Checklist to Help Make Surgery Safer.” World Health Organization Press Release. June 25, 2008.
    [4] Ibid.
    [5] “Safety Checklist for Ops Launched.” BBC News. June 25, 2008.
    [6] Black, Cherie. “Surgery Checklist Is all About the Patient.” Seattle-Post Intelligencer. June 25, 2008.
    [7] “New Checklist to Help Make Surgery Safer.” World Health Organization Press Release. June 25, 2008.
    [8]  Ibid.
    [9] Guiden, Mary. “UWMC Takes Part in WHO Safe Surgery Checklist Initiative.” UWeek.org. July 10, 2008.
    [10] “New Checklist to Help Make Surgery Safer.” World Health Organization Press Release. June 25, 2008.
    [11]  Ibid.
    [12] Black, Cherie. “Surgery Checklist Is all About the Patient.” Seattle-Post Intelligencer. June 25, 2008.
    [13]  Ibid.
    [14]  Ibid.
    [15]  Ibid.
    [16]  Ibid.
    [17] “New Checklist to Help Make Surgery Safer.” World Health Organization Press Release. June 25, 2008.



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