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Audit of compliance with WHO surgical safety checklist

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Audit of compliance with the WHO surgical safety checklist

Todd J, Hammond S.

St George’s, University of London

1. Aims
The aims of this project were twofold:
1. To complete an audit on the level of compliance to the WHO surgical safety checklist in operating theatres at St George's Hospital.
2. To obtain qualitative data on compliance to the WHO surgical safety checklist in operating theatres at St George's Hospital, London.

2. Introduction

Half of all surgical complications are regarded as avoidable (1). In 2008 the WHO recommended the introduction of a Surgical Safety Checklist as a tool to ensure the safety of operations by eliminating these preventable mistakes and oversights that occur before, during and after surgery which may lead to mortality (2).


The checklist (Fig. 1) is composed of three stages. These checks are to be carried out by a checklist coordinator prior to anaesthesia (Sign In), incision (Time Out) and before the patient leaves the theatre (Sign Out). Each stage must be completed prior to progressing the surgery.  The checklist implementation is aimed at improving safety practices, infection control and communication among the surgical team.


The use of the checklist has been shown to have a significant effect on patient outcomes, reducing patient death from 1.5% to 0.8% (3). The NHS has mandated its use for every patient undergoing surgery, including local anaesthesia, for this reason and has recommended the addition of a brief and a debrief to the process to improve communication (4).


This audit was done to establish compliance with this checklist. Additionally, a qualitative measure was added to record data on the communication aspect of the checklist. This was used to gain insight into how the checklist was being used in theatres to facilitate a Shared Mental Model (5).    

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