International Orthopaedics

, Volume 35, Issue 6, pp 897–901 | Cite as

Use of the WHO surgical safety checklist in trauma and orthopaedic patients

  • Mathew SewellEmail author
  • Miriam Adebibe
  • Prakash Jayakumar
  • Charlie Jowett
  • Kin Kong
  • Krishna Vemulapalli
  • Brian Levack
Original Paper


The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0–16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58–1.37) and 1.6% (RR 0.88; 95% CI 0.34–2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.


Early Complication Improve Patient Safety Proximal Femoral Fracture Orthopaedic Patient Staff Perception 
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  1. 1.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144PubMedCrossRefGoogle Scholar
  2. 2.
    Amalberti R, Auroy Y, Berwick D, Barach P (2005) Five system barriers to achieving ultrasafe health care. Ann Intern Med 142:756–764PubMedGoogle Scholar
  3. 3.
    Gawande AA, Thomas EJ, Zinner MJ, Brennan TA (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75PubMedCrossRefGoogle Scholar
  4. 4.
    Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276PubMedCrossRefGoogle Scholar
  5. 5.
    Catchpole K, Mishra A, Handa A, McCulloch P (2008) Teamwork and error in the operating room: analysis of skills and roles. Ann Surg 247:699–706PubMedCrossRefGoogle Scholar
  6. 6.
    Lingard L, Espin S, Whyte S et al (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13:330–334PubMedCrossRefGoogle Scholar
  7. 7.
    World Alliance for Patient Safety (2008) WHO guidelines for safe surgery. World Health Organisation, GenevaGoogle Scholar
  8. 8.
    WHO (2008) The Surgical Safety Checklist. World Health Organisation, Geneva. Accessed 5 August 2010
  9. 9.
    Haynes AB, Weiser TG, Berry WR et al (2009) A Surgical Safety Checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499PubMedCrossRefGoogle Scholar
  10. 10.
    Khuri SF, Daley J, Henderson W et al (1995) The national veterans administration surgical risk study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 180:519–531PubMedGoogle Scholar
  11. 11.
    National Patient Safety Agency. (2009) Patient Safety Alert UPDATE. NPSA, London. Accessed 5 August 2010
  12. 12.
    Torholm C, Broeng L, Jorgensen PS et al (1991) Thromboprophylaxis by low-molecular weight heparin in elective hip surgery. A placebo controlled study. J Bone Joint Surg Br 73:434–438PubMedGoogle Scholar
  13. 13.
    Pitto RP, Hamer H, Heiss-Dunlop W, Kuehle J (2004) Mechanical prophylaxis of deep-vein thrombosis after total hip replacement: a randomised clinical trial. J Bone Joint Surg Br 86:639–642PubMedCrossRefGoogle Scholar
  14. 14.
    Warwick D, Friedman RJ, Agnelli G et al (2007) Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the global orthopaedic registry. J Bone Joint Surg Br 89:799–807PubMedCrossRefGoogle Scholar
  15. 15.
    Blanco M, Clarke JR, Martindell D (2009) Wrong site surgery near misses and actual occurrences. AORN J 90:215–222PubMedCrossRefGoogle Scholar
  16. 16.
    Reuther F (2009) Avoidance of wrong site surgery. Experiences by the introduction of measures for quality control and patient safety in a surgical casualty hospital. Unfallchirurg 112:675–678PubMedCrossRefGoogle Scholar
  17. 17.
    Prokuski L (2008) Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg 16:283–293PubMedGoogle Scholar
  18. 18.
    Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88:943–948PubMedCrossRefGoogle Scholar
  19. 19.
    Berenholtz SM, Pronovost PJ, Lipsett PA et al (2004) Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 32:2014–2020PubMedCrossRefGoogle Scholar
  20. 20.
    Lingard L, Regehr G, Orser B et al (2008) Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anaesthesiologists to reduce failures in communication. Arch Surg 143:12–18PubMedCrossRefGoogle Scholar
  21. 21.
    Sexton JB, Makary MA, Tersigni AR et al (2006) Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel. Anaesthesiology 105:877–884CrossRefGoogle Scholar
  22. 22.
    Makary MA, Sexton JB, Freischlag JA et al (2006) Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 202:746–752PubMedCrossRefGoogle Scholar
  23. 23.
    Taylor B, Slater A, Reznick R (2010) The surgical safety checklist effects are sustained, and team culture is strengthened. Surgeon 8:1–4PubMedCrossRefGoogle Scholar
  24. 24.
    Sarker SK, Vincent C (2005) Errors in surgery. Int J Surg 31:75–81CrossRefGoogle Scholar
  25. 25.
    Pitto RP, Young S (2008) Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance. Int Orthop 32:331–336PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Mathew Sewell
    • 1
    Email author
  • Miriam Adebibe
    • 1
  • Prakash Jayakumar
    • 1
  • Charlie Jowett
    • 1
  • Kin Kong
    • 1
  • Krishna Vemulapalli
    • 1
  • Brian Levack
    • 1
  1. 1.Trauma and OrthopaedicsThe Royal National Orthopaedic HospitalLondonUK

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