Five steps to improving perioperative communications and teamwork using the WHO Surgical Safety Checklist

The World Health Organisation (WHO) Surgical Safety Checklist launched June 2008, was adapted by the National Patient Safety Agency (NPSA) and issued as an Alert to the NHS in England and Wales, in January 2009.
Patient Safety First is recognised by the NPSA as leading support for the implementation of the Checklist across the NHS for England.

Click here to view "5 steps to safer surgery" video on www.patientsafetyfirst.nhs.uk

• The Checklist is a tool to improve perioperative safety for patients

• It is expected that by 1st February 2010, as a minimum, the Checklist will be used for all surgical interventions (NPSA Alert. February 2009)

• To improve communication and teamwork, Patient Safety First is encouraging teams to include in their use of the Checklist a briefing before the list starts and a de-briefing at the end

• The five steps of Briefing, Sign In, Time Out, Sign Out and De-brief improve patient safety through enhanced team performance, increased reliability of key clinical processes and deliberate planning for variations in expected care

• Adding briefings before the lists starts and de-briefings at the end of the list, in addition to the Checklist, further improves communication between the team (references: 2,3,4,5,6)

• The Checklist can be adapted to suit local clinical environments and different specialties but it is recommended that the core content, which is based upon international evidence and opinion, be used (1). Specific items of the Checklist may be moved to different steps in the five step process

• To be effective, all members of the surgical team contributing to the patient’s care must be present at the appropriate step

• The time invested throughout the list, to effectively perform the five steps should be considered an essential part of professional practice. The universal experience is that the benefits gained far exceed the time invested to go through the five steps

• The five steps for improved perioperative communication have the explicit support of all royal colleges and professional bodies.

1. Haynes A. et al, (2009). A Surgical Safety Checklist to reduce Morbidity and Mortality in a global population. The New England Journal of Medicine. 360 (5) pp. 491-499.
2. McCulloch,P. Mishra,A. Handa,A. Dale,T. Hirst,G. Catchpole,K. (2009). The effects of aviation -style non-technical skills training on technical performance and outcome in the operating theatre. Quality and Safety in Healthcare. 18. pp. 109-115.
3. Catchpole,K. Mishra,A. Handa,A. McCulloch,P. (2008). Teamwork and error in the operating room: Analysis of skills and roles. Annals of surgery. 247(4). pp. 669-706.
4. Mishra,A. Catchpole,K. Dale,T. McCulloch,P. (2008). The influence of non-technical performance on technical performance in laparoscopic cholycystectomy. Surgical endoscopy and other interventional techniques. 22(1). pp.68-73.
5. Catchpole,K. Giddings,A. De Laval,M. Peek,G. Godden,P. Utley,M. Gallivan,S. Hirst,G. Dale,T. (2006). Identification of systems failures in successful paediatric cardiac surgery. ~Ergonomics. 49(5-6). pp.567-588.
6. Carthey,J. Clarke,J. (2009). The ‘How to guide’ for implementing human factors in healthcare. Patient Safety First. www.patientsafetyfirst.nhs.uk

August 2009