Definition
The WHO Surgical Safety Checklist is a 19-item, three-pause-point checklist developed by Atul Gawande's team in collaboration with the World Health Organization between 2006 and 2008. It is the central artefact of The Checklist Manifesto. The list is short by design (runnable in about two minutes), opened by the circulating nurse rather than the surgeon, and structured to combine task checks for the simple killers of surgery (infection, bleeding, anaesthesia) with a team briefing for the complex fourth killer (the unexpected).
The 2008 multi-hospital trial — published in the New England Journal of Medicine in January 2009 — showed major complications falling 36 percent and deaths falling 47 percent across hospitals as varied as Auckland City Hospital and a rural Tanzanian district hospital.
Why it matters
How it works
The list is organised around three pause-points threaded through the surgical workflow.
- Before anaesthesia (7 checks). Patient identity and consent verified; surgical site marked; pulse oximeter on and working; allergies known; airway risk assessed and equipment ready; high-blood-loss risk anticipated with IV access and blood ready.
- Before incision (7 checks). Everyone introduced by name and role; correct patient, site, and procedure confirmed by all; antibiotic given on time or judged unnecessary; required imaging displayed; surgeon briefs duration / blood loss / concerns; anaesthesia briefs plan; nursing briefs equipment, sterility, and concerns.
- Before the patient leaves the room (5 checks). Procedure name recorded correctly; specimens labelled; needles, sponges, and instruments accounted for; equipment problems flagged; team reviews recovery plan together.
The mechanism of action implicated by the trial was not the single-item gains (antibiotic timing, pulse oximetry, wrong-site prevention) but the broader communication improvement — staff surveys showed a strong correlation between teamwork score improvement and reduction in complications. Of the 250+ staff who used it for three months, 20 percent still found it awkward; 93 percent said they would want it used in their own surgery.