Decade of improved outcomes for patients thanks to Surgical Safety Checklist

Leading figures in health are celebrating ten years of a checklist for surgical teams which has saved countless lives and improved outcomes for patients in England and around the world.

The Surgical Safety Checklist is a simple tool designed to improve communication and teamwork by bringing together the surgeons, anaesthesia providers and nurses involved in care to confirm that critical safety measures are performed before, during and after an operation.

Launched by the World Health Organization (WHO) in June 2008, with substantial input from UK clinicians, the checklist was mandated for use in the NHS in January 2009. It is now in standard use across the UK as well as worldwide.

A wide range of studies and evaluations since 2008 have shown the checklist to reduce the rate of deaths and surgical complications by as much as one-third in the facilities where it is used.

Further improvements include cost savings and better communication between staff members, and similar checklists are now also in use in a range of other clinical areas, including childbirth, emergency departments, and intensive care units.

The operating theatre is the most common site for adverse surgical incidents, with errors occurring in nearly 15% of all patients globally, and some international studies suggesting that surgery may be responsible for up to 1 million deaths every year, and an additional 7 million postoperative complications.

Thanks to funding provided by the U.K. during its EU Presidency in 2005, and with extensive involvement from UK clinicians, WHO started work to address this in 2006, producing the first ever global guidelines for safe surgery, which was then developed into the Surgical Safety Checklist, modelled on the pre-flight checklist pilots undertake.

Pauline Philip, National Director for Emergency and Elective Care for the NHS in England, was previously Director for Patient Safety at the World Health Organization where she led the development of the checklist, and she continues to help promote surgical safety around the world as honorary CEO of the international NGO Lifebox.

Pauline Philip said: “The safety of patients should always be the number one priority for the NHS, and for any health system around the world. It was a privilege to work with Lord Darzi and 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.”

Between October 2007 and September 2008, the effect of the checklist was studied in eight hospitals in eight cities, including St Mary’s Hospital in Paddington, where the local lead was Lord Ara Darzi.

Those pilots found that use of the checklist reduced the rate of deaths and surgical complications by more than one-third across all eight pilot hospitals. The rate of major inpatient complications dropped from 11% to 7%, and the inpatient death rate following major operations fell from 1.5% to 0.8%.

Speaking at an event organised by Lifebox and the Royal Society of Medicine in London to celebrate a decade of the checklist’s adoption in the NHS, Lord Darzi said: “10 years on from the introduction of the WHO Surgical Safety Checklist we have seen considerable improvements in the safety of patients undergoing surgery. The impact of this pivotal innovation extends well beyond the surgical domain, prompting positive changes in the wider global patient safety movement. We must not allow healthcare to become complacent – and in the coming decade, we need to adopt behavioural, digital and technological innovations, to ensure we fulfil our commitment to improving patient safety worldwide.”

The checklist is a simple 19-item tool which addresses serious and avoidable surgical complications, by ensuring that critical steps outlined in the guidelines are done in every surgery, every time, everywhere. It also serves as a critical communication tool for the operating theatre team.

The checklist’s 3-pause point structure represents natural breaks in the surgical flow, and emphasises time points where changes can be made before it’s too late. Each item within these pause points serves either to trigger a process check of a critical safety step, or prompt a discussion to ensure a common understanding of the patient’s specific history, the surgical plan, and any potential problems that could arise during the procedure.

The checklist was launched in June 2008, with pledges of support from leading health organisations including the Royal Colleges of Surgeons, Anaesthetists, Obstetricians and Nurses.

Professor Derek Alderson, President of the Royal College of Surgeons said: “The WHO surgical safety checklist has demonstrated that even simple innovations can have profound patient safety benefits in healthcare. Since its introduction, countless harmful incidents have been avoided and it has helped to create a safety first culture in the NHS. There is no excuse for surgical teams not to use it.

“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.”

The checklist has now been adopted in a range of countries around the world. In England, it continues to form the basis of effort to improve safety in hospitals, and surveys have shown it enjoys strong support from patients.