The 19-Item WHO Surgical Safety Checklist
In 2008, the World Health Organization (WHO) launched its 'Safe Surgery Saves Lives' initiative to minimize adverse events during surgical procedures globally. The cornerstone of this program is a concise, 19-item surgical safety checklist, designed to be used at three distinct phases of an operation. By standardizing and reinforcing communication among surgical team members, the checklist helps prevent avoidable errors and improves patient outcomes.
The Three Phases of the Surgical Checklist
The 19 items are addressed in three phases to ensure continuous patient safety:
1. Sign In (Before Anesthesia Induction)
This phase includes confirming patient identity, consent, site marking, and checking anesthesia equipment, medications, pulse oximeter, allergies, and risks.
2. Time Out (Before Skin Incision)
Before incision, the team confirms introductions, verifies patient, procedure, and site, checks antibiotic prophylaxis, discusses critical events, and confirms imaging.
3. Sign Out (Before Patient Leaves Operating Room)
Before leaving the operating room, the team confirms the procedure, verifies counts (instruments, sponges, needles), checks specimen labeling, and discusses recovery.
The Impact of Surgical Checklists: WHO vs. Local Variations
While the WHO's 19-item checklist offers a global framework, hospitals often adapt it to their specific needs. These local variations may have a different number of items but maintain the core focus on communication and safety. For more information, see {Link: surgicalsafety.com https://www.surgicalsafety.com/blog/who-surgical-safety-checklist}.
Comparison of Standard WHO vs. Adapted Checklists
| Feature | Standard WHO 19-Item Checklist | Local or Adapted Checklist Variations |
|---|---|---|
| Number of Items | Exactly 19 items. | Can vary depending on local needs or specialization. |
| Phases of Use | Three standard phases: Sign In, Time Out, Sign Out. | May include additional phases, such as a 'Pre-operative/ward check' or 'Check In'. |
| Focus | Broadly applicable to most surgical procedures globally. | Can be tailored for specific surgical specialties (e.g., pediatric, orthopedic). |
| Design | Developed for simplicity and global applicability. | Can be more detailed or specific to address local compliance issues or identified shortfalls. |
| Implementation | Serves as the basis for hospital protocols worldwide. | Requires local adaptation and ongoing auditing for maximum effectiveness. |
| Evidence | Widely supported by extensive research showing reductions in morbidity and mortality. | Effectiveness depends on local implementation quality and team buy-in. |
The Importance of Adherence
Consistent use is crucial for the checklist's effectiveness, regardless of the number of items. Barriers like rushing or communication issues can hinder compliance. The checklist should be seen as a safety tool promoting a culture of open communication.
Conclusion
The number of items is less important than the consistent use and teamwork the checklist promotes. The 19-item WHO checklist is a standard that improves safety. Understanding this process helps prevent errors. For original research, see the {Link: New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMsa0810119}.
