WHO and HSPH Collaborate for Safe Surgery Checklists to Prevent Deaths and Injuries

For Immediate Release: Tuesday, June 24, 2008

Boston, MA– The World Health Organization and collaborators from the Harvard School of Public Health (HSPH) have launched a Safe Surgery initiative to introduce new safety checklists for surgical teams to use around the world as a simple and effective way to reduce millions of deaths and injuries from medical errors during major surgery. The effort has been led by Dr. Atul Gawande, Associate Professor of Health Policy and Management at HSPH, whose team developed the surgical checklists and introduced them in hospitals in eight pilot sites around the world to demonstrate that following these checklists could significantly reduce death and injury. The global volume of major surgical procedures has reached 234 million according to an analysis by Prof. Gawande and lead author Dr. Thomas Weiser, research fellow in the HSPH Department of Health Policy and Management, that appears online June 25, 2008 in The Lancet. This unprecedented and growing volume of surgery suggests that the safety of surgical care is an urgent public health problem and presents an opportunity to dramatically lower rates of harm through simple interventions.

The global  checklist project is an outgrowth of more than a decade of work at HSPH on patient safety and prevention of medical error by addressing health systems errors and solutions.  Before anesthesia, for example, the surgical checklist requires confirmation that the patient has a safe airway for anesthesia and has proper intravenous lines for resuscitation. Before making a skin incision, the surgery team must check off that it has verbally confirmed the patient’s name, the site and the procedure, and administered an antibiotic to prevent infection. At the end of surgery, nurses must check off that instruments, sponges and needles have been counted, specimens labeled properly and equipment problems addressed.

Countries that have already announced their intention to implement the checklists nationwide are Ireland, Jordan and the UK. The Safe Surgery initiative has been endorsed by scores of professional medical associations worldwide.

Dr. Gawande, a surgeon at Brigham and Women’s Hospital, Boston, is also author of Better: A Surgeon’s Notes on Performance and Complications: A Surgeon’s Notes on An Imperfect Science.

The checklists and other supporting materials are freely available on the WHO Safe Surgery Saves Lives site:
The WHO site http://www.who.int/patientsafety/safesurgery/en/
The checklists themselves: http://www.who.int/patientsafety/safesurgery/tools_resources/technical/en/index.html

For more information contact: Robin Herman
(617) 432-4752

The following is a press release from WHO concerning the Safe Surgery Saves Lives initiative:  


News Release WHO/20

25 June 2008

WHO creates new surgical tool to make operations safer everywhere

25 JUNE 2008 | GENEVA / WASHINGTON DC — With major surgery now occurring at a rate of 234 million procedures per year – one for every 25 people – and studies indicating that a significant percentage result in preventable complications and deaths, the World Health Organization (WHO) launched a new safety checklist for surgical teams to use in operating theatres, as part of a major drive to make surgery safer around the world

“Preventable surgical injuries and deaths are now a growing concern,” said Dr Margaret Chan, Director-General of WHO. “Using the Checklist is the best way to reduce surgical errors and improve patient safety.”

Several studies have shown that in industrial countries major complications are reported to occur in 3-16% of inpatient surgical procedures, with permanent disability or death rates of approximately 0.4-0.8%. In developing countries studies suggest death rates of 5-10 % during major surgery. Mortality from general anaesthesia alone is reported to be as high as one in 150 in parts of sub-Saharan Africa. Infections and other postoperative complications are also a serious concern around the world. These studies suggest that approximately half of these complications may be preventable.

“Surgical care has been an essential component of health systems worldwide for more than a century,” said Dr Atul Gawande, a surgeon and professor at Harvard. “Although there have been major improvements over the last few decades, the quality and safety of surgical care has been dismayingly variable in every part of the world. The Safe Surgery Saves Lives initiative aims to change this by raising the standards that patients anywhere can expect.”

The Safe Surgery Saves Lives initiative is a collaborative effort led by the Harvard School of Public Health today and involving more than 200 national and international medical societies and ministries of health in a effort to meet the goal of reducing avoidable deaths and complications in surgical care. Now, the WHO Surgical Safety Checklist, developed under the leadership of Dr Gawande, identifies a set of surgical safety standards that can be applied in all countries and health settings.

Preliminary results from a thousand patients in eight pilot sites worldwide indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care. Use of the checklist in pilot sites has increased adherence to these standards of care from 36% to 68% and in some hospitals to levels approaching 100%. This has thus far resulted in substantial reductions in complications and deaths in this group. Final results on the checklist effect are anticipated within the next few months.

The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: before induction of anaesthesia (‘Sign In’), before skin incision (‘Time Out’) and before the patient leaves the operating room (‘Sign Out’). In each phase a checklist coordinator must be permitted to confirm that the team has completed its tasks before it proceeds with the operation. For example, during the ‘Sign In’ phase was the surgical site marked and the patient’s known allergies checked, or during the “Sign Out” phase were instruments, sponges and needles counted.

The WHO Guidelines and Checklist released today are the first edition. They will be finalized for dissemination by the end of 2008, after completion of evaluation in 8 pilot sites globally.

Notes to Editor:

  • More information about the second Global Patient Safety Challenge Safe Surgery Saves Lives can be seen at http://www.who.int/patientsafety/
  • The World Alliance for Patient Safety is a World Health Organization programme launched in 2004. The Alliance is chaired by Sir Liam Donaldson, Chief Medical Officer of the United Kingdom.
  • The World Alliance for Patient Safety issues its 2006-2007 Progress Report and 2008-2009 Forward Programme on the 25 June 2008.


For more information, please contact:

Edward Kelley, Mobile: +41 79 509 0645, E-mail: kelleye@who.int
Martin Fletcher, Tel: +44 7980 616 992, E-mail: martin.fletcher@npsa.nhs.uk.
All press releases, fact sheets and other WHO media material may be found at www.who.int

Photo from iStockphoto.com/Bart Sadowski.