A surgical safety checklist to reduce morbidity and mortality in a global population.
Success in patient safety is generally measured in incremental steps rather than giant leaps, but this pioneering study certainly represents the latter. Eight hospitals with widely differing resources and patient populations were required to implement a checklist based on the World Health Organization's Safe Surgery Saves Lives guidelines. The 19-item checklist focused on three key junctures: sign in (before induction of anesthesia), timeout (immediately before skin incision), and sign out (when the patient is ready to leave the operating room). It also included specific measures to improve teamwork and reduce the risk of surgical site infection. Checklist implementation resulted in significant reductions in mortality and inpatient complications. Checklists have already proved to be a powerful intervention in improving patient safety. This study's senior author, Atul Gawande, wrote about the success of checklists in preventing central-line associated bloodstream infections in a 2007 New Yorker article.