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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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Lane-Fall, M. B., L., J. L. P., Peifer, H. G., Taranti, L. J. D., Collard, M. L., Jablonski, J., Gutsche, J. T., Halpern, S. D., Barg, F. K., & Fleisher, L. A. (2018) · Annals of Surgery · doi:10.1097/sla.0000000000003137 · Cited by 61
Applications of Head-Mounted Displays and Smart Glasses in Vascular Surgery
Lareyre, F., Chaudhuri, A., Adam, C., Carrier, M., Mialhe, C., & Raffort, J. (2021) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2021.02.033 · Cited by 61
Review article: Perioperative checklist methodologies
Weiser, T. G., & Berry, W. R. (2012) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-012-9854-x · Cited by 59
Self-citationLyon, A. R., Dorsey, S., Pullmann, M. D., Silbaugh-Cowdin, J., & Berliner, L. (2014) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-014-0543-7 · Cited by 64
“Idiographic monitoring can be defined as the selection of quantitative variables that have been individually selected or tailored to maximize their relevance to a specific client (Haynes et al. 2009).”
BackgroundThe Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance
Thongprayoon, C., Harrison, A. M., O’Horo, J. C., Berrios, R. A. S., Pickering, B. W., & Herasevich, V. (2014) · Journal of Intensive Care Medicine · doi:10.1177/0885066614558015 · Cited by 60
“47 Days of hospitalization 5 (2-9) 6 (4-11) .”
Kelleher, D. C., Carter, E. A., Waterhouse, L. J., Parsons, S. E., Fritzeen, J. L., & Burd, R. S. (2014) · Academic Emergency Medicine · doi:10.1111/acem.12487 · Cited by 61
The role of the anesthesiologist in perioperative patient safety
Wacker, J., & Staender, S. E. A. (2014) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000000124 · Cited by 66
Brennan, P. A., Holden, C., Shaw, G., Morris, S., & Oeppen, R. S. (2020) · British Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.bjoms.2020.01.030 · Cited by 63
The effect of a simple checklist on frequent pre‐induction deficiencies
Thomassen, Ø., Brattebø, G., Søfteland, E., Lossius, H. M., & Heltne, J. ‐. (2010) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.1399-6576.2010.02302.x · Cited by 60
Current Status of Simulation-Based Training in Graduate Medical Education
Willis, R. E., & Sickle, K. R. V. (2015) · Surgical Clinics of North America · doi:10.1016/j.suc.2015.04.009 · Cited by 60
Eichenberger, A.-S., Haller, G., Cheseaux, N., Lechappe, V., Garnerin, P., & Walder, B. (2011) · European Journal of Anaesthesiology · doi:10.1097/eja.0b013e328347dff5 · Cited by 62
Retained Surgical Items and Minimally Invasive Surgery
Gibbs, V. C. (2011) · World Journal of Surgery · doi:10.1007/s00268-011-1060-4 · Cited by 60
“There are no data, other than individual case reports, on the frequency of retention in hospitals around the world, but every year more than 45 million inpatient procedures are performed in the US and 234 million operations are performed globally [16, 17].”
BackgroundSafe surgery, the human factors approach
O'Connor, T., PAPANIKOLAOU, V. S., & Keogh, I. J. (2009) · The Surgeon · doi:10.1016/j.surge.2009.10.004 · Cited by 60
Lepänluoma, M., Takala, R. S. K., Kotkansalo, A., Rahi, M., & Ikonen, T. S. (2013) · Scandinavian Journal of Surgery · doi:10.1177/1457496913482255 · Cited by 60
“, where the surgical site infections declined almost by half and unplanned reoperations by a quarter (15).”
BackgroundMethodInfluentialMorgan, L. J., New, S., Robertson, E. R., Collins, P. G. S., Rivero‐Arias, O., Catchpole, K. C., Pickering, S. P., Hadi, M., Griffin, D. R., & McCulloch, P. G. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003158 · Cited by 59
Spahn, D. R., Bouillon, B., Coats, T., Duranteau, J., Fernández‐Mondejar, E., Filipescu, D. C., Hunt, B. J., Nardi, G., Neugebauer, E. A. M., Riddez, L., et al. (2010) · Cited by 59
Quality indicators for gastrointestinal endoscopy units
Day, L. W., Cohen, J., Greenwald, D. A., Petersen, B. T., Schlossberg, N., Vicari, J. J., Calderwood, A. H., Chapman, F. J., Cohen, L. B., Eisen, G. M., et al. (2017) · VideoGIE · doi:10.1016/j.vgie.2017.02.007 · Cited by 59
Harris, K., Søfteland, E., Moi, A. L., Harthug, S., Storesund, A., Jesuthasan, S., Sevdalis, N., & Haugen, A. S. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-4888-1 · Cited by 59
“Safety Checklist aimed at providers [21].”
MethodSantos, E., Evans, S. B., Ford, E. C., Gaiser, J. E., Hayden, S. E., Huffman, K. E., Johnson, J. L., Mechalakos, J., Stern, R. L., Terezakis, S. A., et al. (2015) · Journal of Applied Clinical Medical Physics · doi:10.1120/jacmp.v16i3.5431 · Cited by 59
“Checklists have been extensively validated in nonmedical and medical fields for many years, and have proven to be an effective tool in error management and a key instrument in reducing the risk of costly mistakes and improving overall outcomes.(2,3,4,5,6) JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 16, NUMBER…”
BackgroundBerenholtz, S. M., Schumacher, K., Hayanga, A. J., Simon, M., Goeschel, C. A., Pronovost, P. J., Shanley, C. J., & Welsh, R. (2009) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(09)35055-2 · Cited by 59
Nurses' Knowledge of Evidence-Based Guidelines for the Prevention of Surgical Site Infection
Labeau, S. O., Witdouck, S., Vandijck, D. M., Claes, B., Rello, J., Vandewoude, K., Lizy, C., Vogelaers, D., Blot, S. I., & on behalf of the Executive Board of the Flemish Society for Critical Care Nurses. (2009) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2009.00177.x · Cited by 59
Rosen, A. K., Loveland, S. A., Shin, M. H., Shwartz, M., Hanchate, A. D., Chen, Q., Kaafarani, H. M. A., & Borzecki, A. M. (2012) · Medical Care · doi:10.1097/mlr.0b013e318270c0f7 · Cited by 59
“The establishment of surgical checklists, training of staff in patient safety, hospital-wide efforts to reduce hospital-acquired infections, and developing incentives to improve care are just a few examples of possible steps hospitals can take to reduce readmissions.(35) Moreover, early follow-up and monitoring of sur…”
BackgroundThe World Health Organization Surgical Safety Checklist
Sparkes, D. J., & Rylah, B. G. (2010) · British Journal of Hospital Medicine · doi:10.12968/hmed.2010.71.5.47908 · Cited by 57
Surgical safety checklists in developing countries
Vivekanantham, S., Ravindran, R. P., Shanmugarajah, K., Maruthappu, M., & Shalhoub, J. (2013) · International Journal of Surgery · doi:10.1016/j.ijsu.2013.10.016 · Cited by 59
Morgan, L. J., Pickering, S. P., Hadi, M., Robertson, E. R., New, S., Griffin, D. R., Collins, P. G. S., Rivero‐Arias, O., Catchpole, K. C., & McCulloch, P. G. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003204 · Cited by 59
Petrovic, M. A., Aboumatar, H. J., Scholl, A. T., Gill, R. S., Krenzischek, D. A., Camp, M. S., Senger, C. M., Deng, Y., Chang, T. Y., Xie, Y. J., et al. (2014) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2014.09.007 · Cited by 58
“Other studies have lacked active participation of surgeons, anesthesiologists, and intensivists, who are all crucial to a successful handoff [16-18].”
BackgroundResultInfluentialGraber, C. J., Jones, M., Glassman, P. A., Weir, C. R., Butler, J. M., Nechodom, K. E., Kay, C. L., Furman, A. E., Tran, T. T., Foltz, C., et al. (2015) · Hospital Pharmacy · doi:10.1310/hpj5011-1011 · Cited by 59
Providing Anesthesia Care in Resource-limited Settings
Ariyo, P. T., Trelles, M., Helmand, R., Amir, Y., Hassani, G. H., Mftavyanka, J., Nzeyimana, Z., Akemani, C., Ntawukiruwabo, I. B., Charles, A., et al. (2016) · Anesthesiology · doi:10.1097/aln.0000000000000985 · Cited by 59
Preventable Adverse Events in Surgical Care in Sweden
Nilsson, L. M., Risberg, M. B., Montgomery, A. K., Sjödahl, R. I., Schildmeijer, K. G. I., & Rutberg, H. (2016) · Medicine · doi:10.1097/md.0000000000003047 · Cited by 59
“The World Health Organization ‘‘safe surgery checklist’’ used in the operating theatre can reduce mortality and morbidity after surgery.(15,16) It was introduced in Sweden 2009 and has become widely spread.”
BackgroundA failure modes and effects analysis study for gynecologic high-dose-rate brachytherapy
Mayadev, J., Dieterich, S., Harse, R., Lentz, S., Mathai, M. G., Boddu, S., Kern, M., Courquin, J., & Stern, R. L. (2015) · Brachytherapy · doi:10.1016/j.brachy.2015.06.007 · Cited by 59
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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