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A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population
Open accessAbstract
BACKGROUND: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery. METHODS: Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation. RESULTS: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). CONCLUSIONS: Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
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“We chose to combine several educational and process changes into a single bundled intervention because numerous successful patient-safety interventions have used this approach.1,2,40”
From Changes in medical errors after implementation of a handoff program (2014) · cites this paper as [2]
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“The routine use of surgical safety checklists can reduce perioperative complications.”
From Society for Maternal-Fetal Medicine Special Statement: Surgical safety checklists for cesarean delivery (2021) · cites this paper as [3]
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“Surgical safety checklists, such as the one developed by the World Health Organization (WHO), 2 have been shown to reduce serious perioperative complications and death by 30% to 40% when implemented across a wide range of hospital settings.3,4”
From Society for Maternal-Fetal Medicine Special Statement: Surgical safety checklists for cesarean delivery (2021) · cites this paper as [3]
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“Studies demonstrating reduced morbidity and mortality with the use of a surgical safety checklist include detailed implementation programs involving extensive staff engagement and education.3,4,9”
From Society for Maternal-Fetal Medicine Special Statement: Surgical safety checklists for cesarean delivery (2021) · cites this paper as [3]
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“This problem may help to explain apparently contradictory findings about the value of surgical checklists, for example.47–49”
From Demystifying theory and its use in improvement (2015) · cites this paper as [47]
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ResultDeconstructing intraoperative communication failures
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“Although so far research shows very little quantitative evidence on positive results of team interventions on team effectiveness, there is emerging evidence that team interventions that include technical as well as non-technical skills might lead to better outcomes [20, 31].”
BackgroundInfluentialFuture of Electronic Health Records: Implications for Decision Support
Rothman, B. S., Leonard, J. C., & Vigoda, M. M. (2012) · Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine · doi:10.1002/msj.21351 · Cited by 124
A review of the effect of skin pigmentation on pulse oximeter accuracy
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State of science: human factors and ergonomics in healthcare
Hignett, S. M., Carayon, P., Buckle, P., & Catchpole, K. C. (2013) · Ergonomics · doi:10.1080/00140139.2013.822932 · Cited by 123
“Checklists, briefings and debriefings have also been explored with success (Lingard et al. 2008; Berenholtz et al. 2009; de Vries et al. 2009; Haynes et al. 2009).”
BackgroundAssociation Between Implementation of a Medical Team Training Program and Surgical Morbidity
Young‐Xu, Y. (2011) · Archives of Surgery · doi:10.1001/archsurg.2011.762 · Cited by 123
Review article: Crisis resource management in emergency medicine
Carne, B., Kennedy, M., & Gray, T. (2011) · Emergency Medicine Australasia · doi:10.1111/j.1742-6723.2011.01495.x · Cited by 137
“It is recognized that the performance of complex tasks is impaired by factors to do with the self (fatigue, inexperience, ill health, lack of knowledge) and environmental factors (interruptions, handovers, production pressure, equipment failure).(23,24) These issues, together with the HALTS factors – being hungry, ang…”
BackgroundDanger points, complications and medico-legal aspects in endoscopic sinus surgery
Hosemann, W. G., & Draf, C. (2013) · Europe PMC (PubMed Central) · doi:10.3205/cto000098 · Cited by 127
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“itionally been preoccupied with high-income countries (HICs), recent years have seen a shift of focus to lowincome countries (LICs) [1-3].”
BackgroundLendvay, T. S., Brand, T. C., White, L. W., Kowalewski, T. M., Jonnadula, S., Mercer, L. D., Khorsand, D. A., Andros, J., Hannaford, B., & Satava, R. M. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2013.02.012 · Cited by 122
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Rwandan Surgical and Anesthesia Infrastructure: A Survey of District Hospitals
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Self-citationEngagement in research: an innovative three-stage review of the benefits for health-care performance
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Human factors and error prevention in emergency medicine
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CPD of the future: a partnership between quality improvement and competency‐based education
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“003).(129) The current WHO SSC (2009) aims to achieve SAP within 60 minutes prior to incision and assessment of patient allergies, both of which optimise appropriate antibiotic use.”
BackgroundA comprehensive obstetrics patient safety program improves safety climate and culture
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Evaluation of Postoperative Handover Using a Tool to Assess Information Transfer and Teamwork
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Self-citationFailures in communication and information transfer across the surgical care pathway: interview study
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“Checklists have been shown to change the outcome of the patients.(11) 12 Almost all participants emphasised the need for the development of tools for standardisation of information transfer.”
Self-citationMortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative
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“U the world.(1) After that publication and the public launch of the checklist, multiple research trials have confirmed the efficacy of checklist-based quality-improvement initiatives using a variety of methodologies, including randomized trials.”
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The problem with making Safety-II work in healthcare
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“⇒ Surgical safety checklist : The surgical safety checklist 47 serves as a means to strengthen perioperative consistency of care and communication.”
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“For ease of use, recommendations should be provided as periprocedural checklists [21].”
BackgroundMorbidity and Mortality With Cytoreductive Surgery and Intraperitoneal Chemotherapy
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Robotic Thyroidectomy: A Framework for New Technology Assessment and Safe Implementation
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Metadata
- Authors
- Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A.-H. S., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C. M., Merry, A. F., Moorthy, K., Reznick, R. K., Taylor, B., & Gawande, A. A.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Ministry of Health (JO)
- University of Washington (US)
- University of the Philippines Manila (PH)
- St. Stephen’s Hospital (IN)
- St. Francis Referral Hospital (TZ)
- University of Auckland (NZ)
- National Health Service (GB)
- University Health Network (CA)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-01-29
- Volume
- 360
- Issue
- 5
- Pages
- 491-499
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2119472226
- Cited by
- 5,688
- References
- 41
- Citations by year
- 2026: 256 · 2025: 215 · 2024: 256 · 2023: 247 · 2022: 325 · 2021: 335 · 2020: 337 · 2019: 336 · 2018: 340 · 2017: 362 · 2016: 349 · 2015: 406 · 2014: 405 · 2013: 372 · 2012: 363
- FWCI
- 514.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- ResearchSpace (University of Auckland) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- surgical safety checklist, surgical complications, postoperative mortality, non-cardiac surgery, team communication, patient safety, checklist implementation, global health care, in-hospital complications
- MeSH terms
- Humans, Outcome and Process Assessment, Health Care, Postoperative Complications, Prospective Studies, Surgical Procedures, Operative, Safety Management
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