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J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):392-398. doi: 10.4103/joacp.JOACP_328_17.

The World Health Organization Surgical Safety Checklist: An audit of quality of implementation at a tertiary care high volume cancer institution.

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Department of Anesthesia Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India.


Background and Aims:

In 2007, the World Health Organization (WHO) implemented the Surgical Safety Checklist (SSC), which has enhanced the communication between the surgical team members, improved outcomes, decreased complications, and improved patient safety. However, for the checklist to be effective, proper implementation and compliance with the checklist are imperative. The aim of this study was to evaluate the quality of implementation of the WHO SSC during elective surgery at a tertiary referral cancer hospital in India.

Material and Methods:

In this prospective observational study, a trained research nurse passively observed the implementation of selected items from the modified version of the WHO SSC during elective surgeries and evaluated the compliance with the checklist, percentage of items for which the use of the SSC prompted an action, and level of interaction between the key team players during the conduct of the checklist.


We studied 200 surgeries for each part of the SSC. Compliance was 200 (100%), 156 (78%), and 153 (76.5%) for the first, second, and third part of the SSC, respectively. All the three parts were mostly initiated by surgeons [197 (98.5%), 92 (59%), and 136 (88.9%), respectively]. Overall, 131/2200 (5.95%) items in the checklist were carried out only after being prompted during the conduct of the checklist. The interaction between all three representatives was found in only 265/509 (52%) cases.


The quality of implementation of the SSC was found to be suboptimal, with a definite scope for improvement. Compliance with all items on the checklist and active participation by all team members are crucial for successful implementation of the checklist.


Checklist; World Health Organization; communication; patient safety

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