Page last updated at 08:00 GMT, Wednesday, 25 June 2008 09:00 UK

Safety checklist for ops launched

Experts are concerned that complication rates are too high

A safety checklist designed to cut the risk of surgical complications is to be circulated to doctors world-wide.

The list has been drawn up by the World Health Organization (WHO), which says half of complications resulting from major surgery may be preventable.

A Lancet study found that basic safety measures were often overlooked at hospitals around the world.

The WHO estimates that up to 16% of surgical procedures in industrial nations result in major complications.

In developing countries the death rate during major surgery is estimated to be as high as 10%.

Margaret Chan, WHO director general, said: "Preventable surgical injuries and deaths are now a growing concern
Margaret Chan, WHO director general

In parts of sub-Saharan Africa the death rate from general anaesthesia alone is estimated to be as high as one in 150.

Margaret Chan, WHO director general, said: "Preventable surgical injuries and deaths are now a growing concern.

"Using a checklist is the best way to reduce surgical errors and improve patient safety."

Extensive consultation

The WHO checklist has been drawn up by a team at Harvard School of Public Health, following a consultation with more than 200 medical organisations from around the world.


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Its primary aim is to target the three biggest cause of mortality in surgery - preventable infections, preventable complication from bleeding, and safety in anesthesia.

It includes six basic steps in care, including verifying that it is the correct patient, ensuring equipment is not left inside the patient, and administering an antibiotic before making an incision - which cuts the risk of infection by half.

Preliminary results from patients at eight pilot sites - including London, Seattle and Toronto - indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care, leading to a significant cut in complications and deaths.

The study, published in the Lancet, found that before the checklist was used there was a 64% chance that at least one of the procedures was forgotten - with no difference between rich and developing countries.

There have been major improvements in surgical operations in recent years.

But Professor Atul Gawande, of Harvard, said: "The quality and safety of surgical care has been dismayingly variable in every part of the world.

"What we identified was that the idea of a checklist to make sure the basic steps are taken, could make a big difference not only in the poorest part of the world but even in the rich ones."

Doctors enthusiastic

Dr Isabeau Walker, of London's Great Ormond Street Hospital, was consulted during the drawing up of the checklist, and has been using it.

She said: "It is brilliant. A very simple intervention to help people talk to each other, and work better together as a team.

"These are things we do all the time as routine as a team, but having a checklist just gives pause for thought before the start of an operation for us to say 'yes, we have done all that'."

Health Minister Lord Darzi, a practising surgeon, said: "I feel confident that the introduction of the surgical safety checklist will improve the safety of patients who undergo surgery in the UK."

World-wide, an estimated 234 million operations are carried out a year, and about one million people die each year following major surgery.

According the National Patient Safety Agency, there were 129,000 reported incidents in which patients were put at risk in the UK last year.


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