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National Patient Safety Agency

Surgical safety checklist saves lives

11 November 2010

A study conducted in the Netherlands and published on 10 November in the New England Journal of Medicine (NEJM)* confirms an earlier report from the USA, that the use of a surgical safety checklist significantly reduces surgical morbidity and mortality.


The Netherlands study, carried out from October 2007 to March 2009, shows that with the use of a checklist, surgery complications were reduced by more than one-third and deaths reduced by almost half (from 1.5 per cent to 0.8 per cent).


The National Patient Safety Agency (NPSA) has led on the implementation of the World Health Organization (WHO) Surgical Safety Checklist throughout England and Wales.  In January 2009 the NPSA issued a patient safety alert**, requiring NHS organisations to implement the WHO Surgical Safety Checklist for every patient undergoing a surgical procedure.


The NPSA has championed the implementation of the WHO Surgical Safety Checklist through the ‘Patient Safety First’ campaign in England, and ‘1000 Lives’ campaign in Wales.  The NHS was supported with guidance, ‘How to guides’ and other resources. 100 per cent of NHS organisations are now using the checklist and are making significant strides in the use of the ‘5 steps to safer surgery’***. The checklist has been crucial in introducing safer surgery practices to reduce patient harm and the level of surgical complications.


Dr Suzette Woodward, Director of Patient Safety at the NPSA, said: “The Netherlands study clearly validates what we know about the use of a surgical safety checklist, that it significantly reduces surgical morbidity and mortality.


“Operating theatres are high-risk environments and the use of a checklist for every operation saves lives and helps to ensure reliable, safe care for our patients.”


Sir Liam Donaldson, Chairman of the NPSA and the WHO Patient Safety programme, said: “The NPSA has led the implementation of the WHO Surgical Safety Checklist in all NHS acute hospitals and this latest study, from the Netherlands, confirms earlier findings that the routine use of a checklist reduces death and harm amongst patients having surgery.

“Hospitals not using a surgical safety checklist are endangering patient safety. If I were to need an operation, I would want to be treated somewhere using a surgical checklist.”




Notes to editors


1. Media enquiries to the NPSA Press Office:

Dominic Stevenson – 020 7927 9351 / dominic.stevenson@npsa.nhs.uk


Out of hours – 0788 411 5956


2. Following the publication of the Arms Length Body Review on 26 July 2010, the NPSA has stressed the importance for all NHS organisations across England and Wales to continue reporting patient safety incidents through the National Reporting and Learning System. This is so that trends in safety incidents can be identified and acted upon as early as possible.  This aspect of our work will continue within the new proposed structure of the NHS Commissioning Board and we will continue to work together in partnership with NHS organisations to make services even safer for patients.  We will continue to monitor the implementation of all patient safety alerts and guidance.


3. *de Vries EN, Prins HA, Crolla RMPH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010;363:1928-37


4. The NPSA has issued subsequent patient safety alerts with adapted checklists on Cataract Surgery, Interventional Radiology and the imminent Caesarean Section checklist. 


5. **NPSA Surgical Safety Checklist http://www.nrls.npsa.nhs.uk/resources/clinical-specialty/surgery/?entryid45=59860


6. ***5 steps to safer surgery http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/interventions/Perioperativecare/