BULLETIN

Page 26 | Bulletin 92 | July 2015
Should the NHS WHO surgical safety
checklist be updated?
Lisa Grimes
CT3 ACCS Anaesthesia,
West Suffolk Hospital,
Bury St Edmunds
Daniel Stubbs
CT3 ACCS Anaesthesia,
West Suffolk Hospital,
Bury St Edmunds
Nicholas Levy
Consultant in Anaesthesia
and Acute Pain Medicine,
West Suffolk Hospital,
Bury St Edmunds
nicholas.levy@wsh.nhs.uk
CONFLICT OF INTEREST
STATEMENT
Dr N Levy is an
author of the NHS
Diabetes guidelines
on the perioperative
managment of the
surgical patient with
diabetes, as well as the
RCoA representative
to the VTE prevention
board of NHS England.
The WHO surgical
safety checklist
implemented
simple
evidence-based
interventions
in an attempt
to improve
patient care.
Surgery forms a key part of the management of various conditions, with millions
of people worldwide undergoing surgical procedures each year. However, as
well as delivering benefit, surgery may cause harm, and the World Health
Organisation (WHO) estimates that, each year, half a million preventable deaths
related to surgery occur globally. 1 In England and Wales, over 100,000 incidents
relating to surgery, including 271 deaths, were reported to the National Reporting
and Learning Service in 2007. 2
It is now recognised that human factors and
system failures play a key role in errors in
surgery and anaesthesia. Thus, the WHO
launched the ‘Surgical Safety Checklist’ as part
of the ‘Safe Surgery Saves Lives’ campaign
in 2008. 3 The checklist itself was developed
by an international team of experts led by
Dr Atul Gawande at Harvard medical school.
Checklists had been developed by the aviation
industry to help standardize procedures and
mitigate human error on the safe operation of
aircraft. The Harvard team drew lessons from
the aviation industry in the development of the
Surgical Safety Checklist.
The WHO surgical safety checklist implemented
simple evidence-based interventions in
an attempt to improve patient care. These
interventions included positive identification
of patient and correct site of surgery, specific
anaesthetic and surgical concerns and procedures
designed to improve communication. 3
Pilot studies in eight centres across the globe,
including those in high-income settings and
low-to-middle income settings, demonstrated
that correct implementation of the checklist
reduced the complications and mortality
associated with a variety of surgical procedures,
with the death rate falling from 1.5% to 0.8%
(p=0.003), and the inpatient complication
rate falling from 11% to 7% (p