Surgical safety

  • January 11, 2019
  • Posted by: Mouad SBAYLI
  • Category: Resources
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WHO Surgical Safety Checklist 10 years of Culture Change


It is almost 10 years since the Global Surgical Safety Checklist has become a policy in all operating theatres. It was perhaps one of the most radical culture changes in surgery that promoted and ensured a new way of patient safety in the operating theatres.


The WHO surgical safety checklist was derived from airline practices that include promotion of team working and leadership, and minimise errors due Human Factor.


It consists of 5 principle stages:
  • Team Briefing


This happens at the beginning of the surgical list. Surgeons, Anaesthetists and rest of the team members introduce themselves and their roles. They confirm the order the theatre list, main issues of each case, necessary equipment and critical moments of each case.

  • Sign in


This happens before patient receives anaesthesia. By involving the patient, the Anaesthetic team ensure that right patient is having the right procedure at the right site and that patient understood the consent. It is also time to ascertain about allergies and last meal. Team ascertain monitoring is applied before anaesthesia starts.

  • Time out


This happens just before knife to skin or start of the surgical procedure. The Anaesthetic team together with rest of the team carry out the rest of checks that include patient safety during surgery, critical moments during surgery, the amount of blood loss and whether there were arrangements for blood transfusion. It is also time to ascertain whether patient has antibiotic for infection prevention if they are indicated.

  • Sign out


This happens at the end of the procedure before patient is transferred to the recovery area. Checks include name of the procedure, whether there were any complications and special care after the procedure.

  • Debrief


This happens at the end of operating list. The team members discuss good and bad things that happen during the surgical list. Any lessons to be learned and whether there are incidents to be reported to the management. They thank each other and make close to the list.


The WHO surgical safety checklist has become a policy in many countries for many years. It has proven to save lives and improve patient care. It has also shown to improve theatre productivity and save money. Completing the checklist does not cost much apart from getting the team member together.


In Countries like the United Kingdom, the WHO surgical safety checklist has been mandatory in all Hospitals and has been extended to other specialities other than surgical one. For example, Radiology, Intervention Radiology, Endoscopy suites and cardiac laboratories have produced their own safety checklists.


As we are about celebrate the 10th Anniversary of the Checklist, one would argue that patients who do not benefit of such practice are denied basic quality care.


Embedding the practice within an organisation is not taxing. It does need support, education and systems to enforce it to become second nature practice. ‘For Better Health’ has accompanied organisation to establish that practice and would be delighted to assist any other organisation to do the same.

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