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  Table of Contents     
Year : 2015  |  Volume : 61  |  Issue : 3  |  Page : 214-215

Surgical safety checklist: Productive, nondisruptive, and the "right thing to do"

1 Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
2 Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA

Date of Web Publication26-Jun-2015

Correspondence Address:
S P Stawicki
Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0022-3859.159434

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How to cite this article:
Smith E A, Akusoba I, Sabol D M, Stawicki S P, Granson M A, Ellison E C, Moffatt-Bruce S D. Surgical safety checklist: Productive, nondisruptive, and the "right thing to do". J Postgrad Med 2015;61:214-5

How to cite this URL:
Smith E A, Akusoba I, Sabol D M, Stawicki S P, Granson M A, Ellison E C, Moffatt-Bruce S D. Surgical safety checklist: Productive, nondisruptive, and the "right thing to do". J Postgrad Med [serial online] 2015 [cited 2023 Jun 10];61:214-5. Available from:


We read with great interest the article by Oak et al.[1] on the topic of surgical checklist utilization in facilitating operative patient safety. The authors of the manuscript should be congratulated on their contribution to health-care safety. Regardless of the circumstance, operative indications, or the scope of the procedure, it is important to maintain a uniformly standardized approach to the health-care delivery process. Critical to the implementation of any system-wide patient safety measure is the presence of proactive leadership, institutional dialogue, staff training, and built-in avenues for constructive criticism and feedback. [2]

Perhaps the most important contribution of the surgical safety checklist (SSC) is the increased awareness that patient safety spans the entire spectrum of care delivery and involves every member of the surgical team, regardless of the level of experience, operative setting, geographic location, or time of the procedure. [3],[4],[5],[6] The ability to establish and foster the horizontal "team leadership" structure, grounded in shared accountability and personal responsibility, is crucial to the successful implementation of the SSC. [7] Yet, institutional introductions of the surgical checklist are often faced with the criticism that this added safety step creates unnecessary delays in an already busy operating room (OR) schedule, that it does not truly benefit the patient, or that its very presence does not ensure enhanced compliance or greater safety. [8]

The authors of this letter support the notion that the implementation of the SSC must be accompanied by a permanent change in "institutional mindset" and a sustained effort to maintain team focus and a culture of safety. [8] Importantly, communication between hospital leadership and front line practitioners must be open, honest, and constructive in order to obtain the buy-in necessary for the initiative's success. Regarding the concern that SSC increases operative time and introduces unnecessary complexity to an already convoluted process, the authors would like to provide an example from Ohio State University showing that the implementation of the SSC is not disruptive, and that operative times for one of the most commonly performed procedures - laparoscopic cholecystectomy - have not been affected following the introduction of the checklist. More specifically, during the pre-checklist period (2006-2008, average 456 cases per year) the mean time in the OR was 101 min. After the SSC introduction (2009-2012, average 600 cases per year), the mean time in the OR was 100 min. The percentages of cases longer than 90 min were similar at 46% and 52% during the pre- and post-checklist periods, respectively. Subjective observations from St. Luke's University Health Network also support the productive, nondisruptive nature of the SSC as well as its pivotal role in raising and maintaining organizational awareness of a safety culture. This is consistently most evident when the surgeon makes the SSC a priority and leads the "time out" process. When evaluating the SSC in the context of a culture of safety, it makes perfect sense that the entire operative team should review all critical variables jointly, at one time, and without interruptions, thus avoiding inefficient, poorly coordinated, duplicative efforts.

It is the authors' hope that institutions around the globe embrace the SSC as a critical component of the overall multifaceted approach to enhance patient safety and reduce operative morbidity, mortality, and never events. [5],[6],[7] We again congratulate Oak et al.[1] on their outstanding contribution to the field of surgical patient safety.

 :: References Top

Oak SN, Dave NM, Garasia MB, Parelkar SV. Surgical checklist application and its impact on patient safety in pediatric surgery. J Postgrad Med 2015;61:92-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Papaconstantinou HT, Jo C, Reznik SI, Smythe WR, Wehbe-Janek H. Implementation of a surgical safety checklist: Impact on surgical team perspectives. Ochsner J 2013;13:299-309.  Back to cited text no. 2
Henderson D, Carson-Stevens A, Bohnen J, Gutnik L, Hafiz S, Mills S. Check a box. Save a life: How student leadership is shaking up health care and driving a revolution in patient safety. J Patient Saf 2010;6:43-7.  Back to cited text no. 3
Moffatt-Bruce SD, Ellison EC, Anderson HL 3 rd , Chan L, Balija TM, Bernescu I, et al.; OPUS 12 Foundation, Inc. Multi-Center Trials Group. Intravascular retained surgical items: A multicenter study of risk factors. J Surg Res 2012;178:519-23.  Back to cited text no. 4
Stawicki SP, Cook CH, Anderson HL 3 rd , Chowayou L, Cipolla J, Ahmed HM. et al.; OPUS 12 Foundation Multicenter Trials Group. Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval. Am J Surg 2014;208:65-72.  Back to cited text no. 5
Bergs J, Hellings J, Cleemput I, Zurel Ö, De Troyer V, Van Hiel M, et al. Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. Br J Surg 2014;101:150-8.  Back to cited text no. 6
Stawicki SP, Galwankar SC, Papadimos TJ, Moffatt-Bruce SD. Fundamentals of Patient Safety in Medicine and Surgery. New Delhi: Wolters Kluwer Health (India) Pvt Ltd; 2014. p. 66-73.  Back to cited text no. 7
Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014;370:1029-38.  Back to cited text no. 8


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