1. Pool, Sarah R. RN, MS

Article Content

The Agency for Healthcare Research and Quality has recently challenged hospital leaders to help make healthcare institutions high-reliability organizations.1 High-reliability organizations are high-risk industries with few errors. One tool used by many high-reliability organizations is a checklist.


In the 2009 Joint Commission National Patient Safety Goals, Elements of Performance for Universal Protocol UP.01.01.01, a checklist is required in the preprocedural area.2 The Joint Commission states that the checklist should be used to ensure that all relevant documents are available and have been reviewed, and that all blood products, implants, and special equipment are available prior to the start of the procedure and matched to the patient.3


Surgical safety

The Joint Commission requirement calls for a preprocedural checklist, however, a perioperative checklist will incorporate the surgical safety elements that impact the entire perioperative setting. The World Health Organization (WHO) has developed a Surgical Safety Checklist4 to be used in the perioperative setting. The checklist connects surgical quality elements together, including the Universal Protocol, anesthesia safety, team communication, prevention of surgical site infections, and the count process. The WHO checklist was evaluated in ORs in eight cities worldwide. Preliminary results demonstrate use of the checklist increased adherence to standards of care from 36% to 68% and to 100% in some hospitals, reducing morbidity and mortality for surgical patients.5


The WHO Surgical Safety Checklist also includes a briefing process. Poor communication is one of the most frequent causes of adverse patient events. However, performing preoperative briefings can reduce communication problems. In one study, communication failures per procedure were reduced from 3.95 to 1.31 (p < 0.001) with OR briefings.6 Team communication during briefings can also help perioperative staff be more prepared during the surgical procedure. Briefings have been shown to reduce OR delays by 31%.7


Tailor made

To make the WHO Surgical Safety Checklist more valuable to your operating suite, tailor it to your practice to gain buy-in from staff members. Try the checklist in several different areas with different staff members and collect their feedback before implementing. Also, be sure all team members have been educated properly on the checklist.


Whether your hospital uses the WHO Surgical Safety Checklist or creates its own, the entire perioperative team should be engaged during safety checks. Remember, even though your perioperative staff members may currently be performing necessary elements of care, there's always room for improvement to ensure tasks are completed consistently.




1. Agency for Healthcare Research and Quality. Becoming a high reliability organization. [Context Link]


2. The Joint Commission. Accreditation program: hospital national patient safety goals. [Context Link]


3. The Joint Commission. FAQs. [Context Link]


4. World Health Organization. Safe surgery saves lives. [Context Link]


5. World Health Organization. Pilot evaluation of the WHO surgical safety checklist. [Context Link]


6. Lingard L, Regehr G, Orser B, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg. 2008;143(1):12-17. [Context Link]


7. Nundy S, Mukherjee A, Sexton B, et al. Impact of preoperative briefings on operating room delays. Arch Surg. 2008;143(11):1068-1072. [Context Link]