In this article, we welcome the adoption of the WHO surgical checklist to prevent errors in surgical practice. We highlight the scale of the problem and discuss the adoption of this tool in the UK

AB Haynes

Aziz Sheikh

C Vincent

HR Clinton

JA Taylor

Kevin Cleary

KT Kohn

Liam Donaldson

SC Seiden

Sukhmeet S Panesar

English

PubMed

Crossref

The WHO checklist: a global tool to prevent errors in surgery

Abstract In this article, we welcome the adoption of the WHO surgical checklist to prevent errors in surgical practice. We highlight the scale of the problem and discuss the adoption of this tool in the UK.</p

Sheikh Aziz

Cleary Kevin

Panesar Sukhmeet S

Donaldson Liam

Directory of Open Access Journals

Patient Safety in Surgery

Panesar, Sukhmeet S

Cleary, Kevin

Sheikh, Aziz

Donaldson, Liam

Edinburgh Research Explorer

     Edinburgh Research Explorer                                      The WHO checklist: a global tool to prevent errors in surgeryCitation for published version:Panesar, SS, Cleary, K, Sheikh, A & Donaldson, L 2009, 'The WHO checklist: a global tool to prevent errorsin surgery' Patient Safety in Surgery, vol 3, no. 1, pp. 9. DOI: 10.1186/1754-9493-3-9Digital Object Identifier (DOI):10.1186/1754-9493-3-9Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordPublished In:Patient Safety in SurgeryPublisher Rights Statement:© 2009 Panesar et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.General rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 28. Apr. 2017BioMed CentralPage 1 of 2(page number not for citation purposes)Patient Safety in SurgeryOpen AccessLetter to the EditorThe WHO checklist: a global tool to prevent errors in surgerySukhmeet S Panesar*1, Kevin Cleary1, Aziz Sheikh2 and Liam Donaldson3Address: 1National Patient Safety Agency (NPSA), Patient Safety Division, 4-8 Maple Street, London, W1T 5HD, UK, 2Division of Community Health Sciences: GP Section, University of Edinburgh, 20 West Richmond Street, Edinburgh, EH8 9DX, UK and 3Department of Health Richmond House 79 Whitehall, London, SW1A 2NS, UKEmail: Sukhmeet S Panesar* - sukhmeet.panesar@imperial.ac.uk; Kevin Cleary - kevin.cleary@npsa.nhs.uk; Aziz Sheikh - aziz.sheikh@ed.ac.uk; Liam Donaldson - liam.donalson@dh.gsi.gov.uk* Corresponding author    AbstractIn this article, we welcome the adoption of the WHO surgical checklist to prevent errors in surgicalpractice. We highlight the scale of the problem and discuss the adoption of this tool in the UK.BackgroundThe increased complexity of healthcare has led to a corre-sponding increase in the number of medical errors. A sig-nificant proportion (up to 10%) of hospitalized patientsexperience a patient safety incident and nearly half ofthese are preventable. [1] Numerically, this translates tojust under 100,000 preventable patient deaths per year.[2] Approximately 1 in 8 British individuals have a surgi-cal procedure performed each year; [3] these typicallybringing them considerable benefits, but also subjectingthem to significant risk of potentially avoidable harm.Significant advances have been made internationallythrough the World Health Organization's World Alliancefor Patient Safety and through legislation to focusincreased attention on patient safety considerations. Oneof the areas of particularly high priority is the creation ofpatient safety reporting systems which aim to help iden-tify patterns of errors and through so doing facilitatelearning and the formulation of harm reduction strate-gies. [4]The UK has been spearheading the patient safety agendaand is a pioneer in developing the first national repositoryof patient safety events i.e. the Research and LearningService (RLS) database, which is maintained by theNational Patient Safety Agency (NPSA). This is now thelargest database of patient safety incidents in the world.These incidents are arranged categorically. To date, theNPSA has received in excess of 3 million reports [5] ofwhich 450,000 are surgically-related (see Figure 1).The recently launched WHO Surgical Checklist is animportant development, which may help to prevent anumber of these surgical errors. Encouragingly, it has nowbeen adapted for use in England and Wales. [6]One of the key error-prone areas that the surgical checklist[7] can mitigate against is that of 'Wrong-Site Surgery.'Wrong site or wrong patient incidents are rare, but theconsequences can result in considerable harm to thepatient. A recent study revealed 5,940 cases of wrong-sitesurgery (2,217 wrong side surgical procedures and 3,723wrong-treatment/wrong procedure errors) in 13 years. [8]Our review of the RLS database (September 2007 – August2008) revealed 26 (3.6%) cases of wrong patient, 62(8.5%) of wrong side block, 150 (20.7%) of wrong sidemarked on consent form, 78 (10.7%) of wrong sidemarked on patient, 353 (48.6%) of wrong side marked ontheatre list, 11 (1.5%) of wrong site prosthesis and 46Published: 28 May 2009Patient Safety in Surgery 2009, 3:9 doi:10.1186/1754-9493-3-9Received: 11 May 2009Accepted: 28 May 2009This article is available from: http://www.pssjournal.com/content/3/1/9© 2009 Panesar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Publish with BioMed Central   and  every scientist can read your work free of charge"BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime."Sir Paul Nurse, Cancer Research UKYour research papers will be:available free of charge to the entire biomedical communitypeer reviewed and published immediately upon acceptancecited in PubMed and archived on PubMed Central yours — you keep the copyrightSubmit your manuscript here:http://www.biomedcentral.com/info/publishing_adv.aspBioMedcentralPatient Safety in Surgery 2009, 3:9 http://www.pssjournal.com/content/3/1/9Page 2 of 2(page number not for citation purposes)(6.3%) of wrong side surgery. These results are likely to bea gross under-representation of the true number of theseevents as reporting to the RLS is still far from complete. [9]The important study by Haynes et al. [6] has demon-strated that use of a simple checklist can substantially andsignificantly reduce risk of morbidity and mortality asso-ciated with surgery, and given the importance of this find-ing in a field that tends to be characterised by relativelylittle in the way of robust evidence, we have taken the pol-icy decision to nationally implement routine use of thisapproach. [10] Over the next year we expect all NationalHealth Service trusts to have adopted this very simple andeffective intervention.Competing interestsThe authors declare that they have no competing interests.Authors' contributionsSSP contributed to conception, design, analysis, interpre-tation of data, and drafted the manuscript. KC, AS and LDwere involved in analysis and interpretation of data andrevised the manuscript critically for important intellectualcontent. All authors read and approved the final manu-script.Authors' informationSSP is a clinical advisor to the Medical Director, NationalPatient Safety Agency (NPSA), KC is the Medical Director,NPSA, AS is Professor of Primary Care, Research andDevelopment, University of Edinburgh and LD is theChief Medical Officer for England.AcknowledgementsVivian Tang, Clinical Advisor to the Medical Director, NPSA.Bhavesh Patel, Information Analyst, NPSA.VT and BP assisted with review of the incidents presented to the RLS data-base.References1. Vincent C, Neale G, Woloshynowych M: Adverse events in Brit-ish hospitals: preliminary retrospective record review.  BMJ2001, 322(7285):517-9.2. Kohn KT, Corrigan JM, Donaldson MS: To Err Is Human: Building aSafer Health System Washington, DC: National Academy Press; 1999. 3. National Patient Safety Agency. UK Surgical Organisationssign up to World Health Organisation Challenge: Safe Sur-gery Saves Lives   [http://www.npsa.nhs.uk/corporate/news/safe-surgery-saves-lives/]4. Clinton HR, Obama B: Making patient safety the centerpiece ofmedical liability reform.  N Engl J Med 2006, 354(21):2205-8.5. National Reporting and Learning System (NRLS). Organisa-tion Patient Safety Incident Reports   [http://www.npsa.nhs.uk/nrls/patient-safety-incident-data/organisation-reports/organisation-patient-safety-incident-reports/]6. National Patient Safety Agency. WHO Surgical SafetyChecklist   [http://www.npsa.nhs.uk/checklist/]7. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, et al.: Asurgical safety checklist to reduce morbidity and mortality ina global population.  N Engl J Med 2009, 360:491-9.8. Seiden SC, Barach P: Wrong-side/wrong-site, wrong-proce-dure, and wrong patient adverse events: Are they preventa-ble?  Arch Surg 2006, 141(9):931-9.9. Taylor JA, Brownstein D, Christakis DA, et al.: Use of incidentreports by physicians and nurses to document medicalerrors in pediatric patients.  Pediatrics 2004, 114:729-35.10. National Patient Safety Agency. Safe Surgery Saves Lives –moving forward   [http://www.npsa.nhs.uk/nrls/improvingpatientsafety/anaesthesia-and-surgery/whos-safer-surgery-checklist/]Degree of harm for surgical incidents occurring in the R porting and Learning System (RLS) at the NPSA between Janua y 2005 and September 2008Figu 1Degree of harm for surgical incidents occurring in the Reporting and Learning System (RLS) at the NPSA between January 2005 and September 2008.

Springer - Publisher Connector

BioMed CentralPatient Safety in Surgery
ssOpen AcceLetter to the Editor
The WHO checklist: a global tool to prevent errors in surgery
Sukhmeet S Panesar*1, Kevin Cleary1, Aziz Sheikh2 and Liam Donaldson3
Address: 1National Patient Safety Agency (NPSA), Patient Safety Division, 4-8 Maple Street, London, W1T 5HD, UK, 2Division of Community 
Health Sciences: GP Section, University of Edinburgh, 20 West Richmond Street, Edinburgh, EH8 9DX, UK and 3Department of Health Richmond 
House 79 Whitehall, London, SW1A 2NS, UK
Email: Sukhmeet S Panesar* - sukhmeet.panesar@imperial.ac.uk; Kevin Cleary - kevin.cleary@npsa.nhs.uk; Aziz Sheikh - aziz.sheikh@ed.ac.uk; 
Liam Donaldson - liam.donalson@dh.gsi.gov.uk
* Corresponding author    
Abstract
In this article, we welcome the adoption of the WHO surgical checklist to prevent errors in surgical
practice. We highlight the scale of the problem and discuss the adoption of this tool in the UK.
Background
The increased complexity of healthcare has led to a corre-
sponding increase in the number of medical errors. A sig-
nificant proportion (up to 10%) of hospitalized patients
experience a patient safety incident and nearly half of
these are preventable. [1] Numerically, this translates to
just under 100,000 preventable patient deaths per year.
[2] Approximately 1 in 8 British individuals have a surgi-
cal procedure performed each year; [3] these typically
bringing them considerable benefits, but also subjecting
them to significant risk of potentially avoidable harm.
Significant advances have been made internationally
through the World Health Organization's World Alliance
for Patient Safety and through legislation to focus
increased attention on patient safety considerations. One
of the areas of particularly high priority is the creation of
patient safety reporting systems which aim to help iden-
tify patterns of errors and through so doing facilitate
learning and the formulation of harm reduction strate-
gies. [4]
The UK has been spearheading the patient safety agenda
and is a pioneer in developing the first national repository
of patient safety events i.e. the Research and Learning
Service (RLS) database, which is maintained by the
National Patient Safety Agency (NPSA). This is now the
largest database of patient safety incidents in the world.
These incidents are arranged categorically. To date, the
NPSA has received in excess of 3 million reports [5] of
which 450,000 are surgically-related (see Figure 1).
The recently launched WHO Surgical Checklist is an
important development, which may help to prevent a
number of these surgical errors. Encouragingly, it has now
been adapted for use in England and Wales. [6]
One of the key error-prone areas that the surgical checklist
[7] can mitigate against is that of 'Wrong-Site Surgery.'
Wrong site or wrong patient incidents are rare, but the
consequences can result in considerable harm to the
patient. A recent study revealed 5,940 cases of wrong-site
surgery (2,217 wrong side surgical procedures and 3,723
wrong-treatment/wrong procedure errors) in 13 years. [8]
Our review of the RLS database (September 2007 – August
2008) revealed 26 (3.6%) cases of wrong patient, 62
(8.5%) of wrong side block, 150 (20.7%) of wrong side
marked on consent form, 78 (10.7%) of wrong side
marked on patient, 353 (48.6%) of wrong side marked on
theatre list, 11 (1.5%) of wrong site prosthesis and 46
Published: 28 May 2009
Patient Safety in Surgery 2009, 3:9 doi:10.1186/1754-9493-3-9
Received: 11 May 2009
Accepted: 28 May 2009
This article is available from: http://www.pssjournal.com/content/3/1/9
© 2009 Panesar et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 2
(page number not for citation purposes)
Patient Safety in Surgery 2009, 3:9 http://www.pssjournal.com/content/3/1/9Publish with BioMed Central   and  every 
scientist can read your work free of charge
"BioMed Central will be the most significant development for 
disseminating the results of biomedical research in our lifetime."
Sir Paul Nurse, Cancer Research UK
Your research papers will be:
available free of charge to the entire biomedical community
peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central 
yours — you keep the copyright
Submit your manuscript here:
http://www.biomedcentral.com/info/publishing_adv.asp
BioMedcentral
(6.3%) of wrong side surgery. These results are likely to be
a gross under-representation of the true number of these
events as reporting to the RLS is still far from complete. [9]
The important study by Haynes et al. [6] has demon-
strated that use of a simple checklist can substantially and
significantly reduce risk of morbidity and mortality asso-
ciated with surgery, and given the importance of this find-
ing in a field that tends to be characterised by relatively
little in the way of robust evidence, we have taken the pol-
icy decision to nationally implement routine use of this
approach. [10] Over the next year we expect all National
Health Service trusts to have adopted this very simple and
effective intervention.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
SSP contributed to conception, design, analysis, interpre-
tation of data, and drafted the manuscript. KC, AS and LD
were involved in analysis and interpretation of data and
revised the manuscript critically for important intellectual
content. All authors read and approved the final manu-
script.
Authors' information
SSP is a clinical advisor to the Medical Director, National
Patient Safety Agency (NPSA), KC is the Medical Director,
NPSA, AS is Professor of Primary Care, Research and
Development, University of Edinburgh and LD is the
Chief Medical Officer for England.
Acknowledgements
Vivian Tang, Clinical Advisor to the Medical Director, NPSA.
Bhavesh Patel, Information Analyst, NPSA.
VT and BP assisted with review of the incidents presented to the RLS data-
base.
References
1. Vincent C, Neale G, Woloshynowych M: Adverse events in Brit-
ish hospitals: preliminary retrospective record review.  BMJ
2001, 322(7285):517-9.
2. Kohn KT, Corrigan JM, Donaldson MS: To Err Is Human: Building a
Safer Health System Washington, DC: National Academy Press; 1999. 
3. National Patient Safety Agency. UK Surgical Organisations
sign up to World Health Organisation Challenge: Safe Sur-
gery Saves Lives   [http://www.npsa.nhs.uk/corporate/news/safe-
surgery-saves-lives/]
4. Clinton HR, Obama B: Making patient safety the centerpiece of
medical liability reform.  N Engl J Med 2006, 354(21):2205-8.
5. National Reporting and Learning System (NRLS). Organisa-
tion Patient Safety Incident Reports   [http://www.npsa.nhs.uk/
nrls/patient-safety-incident-data/organisation-reports/organisation-
patient-safety-incident-reports/]
6. National Patient Safety Agency. WHO Surgical Safety
Checklist   [http://www.npsa.nhs.uk/checklist/]
7. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, et al.: A
surgical safety checklist to reduce morbidity and mortality in
a global population.  N Engl J Med 2009, 360:491-9.
8. Seiden SC, Barach P: Wrong-side/wrong-site, wrong-proce-
dure, and wrong patient adverse events: Are they preventa-
ble?  Arch Surg 2006, 141(9):931-9.
9. Taylor JA, Brownstein D, Christakis DA, et al.: Use of incident
reports by physicians and nurses to document medical
errors in pediatric patients.  Pediatrics 2004, 114:729-35.
10. National Patient Safety Agency. Safe Surgery Saves Lives –
moving forward   [http://www.npsa.nhs.uk/nrls/improvingpatient
safety/anaesthesia-and-surgery/whos-safer-surgery-checklist/]
Degree of harm for surgical incidents occurring in the R porting and Learning System (RLS) at the NPSA between Janua y 2005 and September 2008Figu 1
Degree of harm for surgical incidents occurring in 
the Reporting and Learning System (RLS) at the 
NPSA between January 2005 and September 2008.Page 2 of 2
(page number not for citation purposes)


A surgical safety checklist to reduce morbidity and mortality in a global population.

Adverse events in British hospitals: preliminary retrospective record review. BMJ

and wrong patient adverse events: Are they preventable? Arch Surg

MS: To Err Is Human: Building a Safer Health System Washington, DC: National Academy Press;

National Reporting and Learning System (NRLS). Organisation Patient Safety Incident Reports [http://www.npsa.nhs.uk/ nrls/patient-safety-incident-data/organisation-reports/organisationpatient-safety-incident-reports/]

Obama B: Making patient safety the centerpiece of medical liability reform.

Safety Agency. UK Surgical Organisations sign up to World Health Organisation Challenge: Safe Surgery Saves Lives [http://www.npsa.nhs.uk/corporate/news/safesurgery-saves-lives/]

Safety Agency. WHO Surgical Safety Checklist [http://www.npsa.nhs.uk/checklist/]

Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Pediatrics

file:///data/core-remote/dit/data/Springer-OA/pdf/286/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTc1NC05NDkzLTMtOS5wZGY=.pdf

The WHO checklist: a global tool to prevent errors in surgery

Abstract

Similar works

Full text

Available Versions

Crossref

Directory of Open Access Journals

Edinburgh Research Explorer

Springer - Publisher Connector