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WHO's checklist for surgery: don't confine it to the operating room

2008; Elsevier BV; Volume: 372; Issue: 9644 Linguagem: Inglês

10.1016/s0140-6736(08)61477-4

1474-547X

EN de Vries, Marja A. Boermeester, DJ Gouma,

Medical Malpractice and Liability Issues

In your Editorial of July 5,1The Lancet WHO's patient-safety checklist for surgery.Lancet. 2008; 372: 1Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar you describe the launch of the Safe Surgery Saves Lives campaign by WHO's World Alliance for Patient Safety.2Humphreys G Checklists save lives.Bull World Health Organ. 2008; 86: 501-502Crossref PubMed Scopus (11) Google Scholar The Alliance has developed a surgical safety checklist that is essentially an expanded timeout procedure, including a debriefing. In recent years, this type of procedure has been widely advocated and implemented.3Lingard L Espin S Rubin B et al.Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR.Qual Saf Health Care. 2005; 14: 340-346Crossref PubMed Scopus (200) Google Scholar, 4Makary MA Holzmueller CG Thompson D et al.Operating room briefings: working on the same page.Jt Comm J Qual Patient Saf. 2006; 32: 351-355PubMed Scopus (82) Google Scholar Although it is unquestionably valuable, it has one major drawback: its timing. In an observation of 170 surgical procedures,5de Vries EN, Hollmann MW, Smorenburg SM, Gouma DJ, Boermeester MA. Development and validation of the SURgical PAtient Safety System (SURPASS) checklist. Qual Saf Health Care (in press).Google Scholar more than 50% of all deviations in surgical processes occurred before or after surgery. Many of these omissions and incidents can and should be corrected at an earlier stage than just before starting surgery, when it could be too late. Not checking the essentials until inside the operating room might lead to compromised safety or postponement of surgery, resulting in substantial psychological burden for the patient. Additionally, the patient is not safely home after surgery: many adverse events originate in the postoperative phase. Therefore, we would like to plead for a checklist that covers the entire surgical pathway from admission to discharge, instead of just the perioperative phase. The surgical patient is at risk; and no less so on the ward or in the recovery room than in the operating theatre. With attitudes starting to change and a safety culture slowly emerging, we now have the opportunity to really improve patients' safety. Let's not be too easily satisfied. We declare that we have no conflict of interest.