1. The WHO Surgical Safety Checklist Metastar January 25 th, 2011

2. Discussion Topics Checklist background Checklist spread

3. The Problem

4. The 3 Central Problems in Surgical Safety Throughout the World Unrecognized as public health issue Lack of data on surgery and outcomes We know what to do, but we dont do it consistently

5. Global Annual Procedure Rates Source: WHO, 2008

6. The Safe Surgery Saves Lives Programme

7. Guiding Principles Simple Widely applicable Measurable Address serious and avoidable surgical complications Zero harm from the Checklist

8. Process Leading to Checklist Brainstorming Analyzing Expert Meeting Small Working Groups Assembling Small Scale Testing/Modification Pilot Study Launch and Dissemination

9. Four Categories for Surgical Standards: CONTROL OF INFECTION AND CONTAMINATION ANESTHESIA AND PATIENT MONITORING SURGICAL OPERATOR QUALITY ASSURANCE

10. Why a Checklist?

16. Pilot Study

17. London, UK EUROEMRO WPRO I SEARO AFRO PAHO I Amman, Jordan Toronto, Canada New Delhi, India Manila, Philippines Ifakara, Tanzania WPRO II Auckland, NZ PAHO II Seattle, USA International Pilot Study 8 Evaluation Sites - Nearly 8,000 Patients

18. SiteCases Inpatient Complication Inpatient Death 152411.6%1.0% 23577.8%1.1% 349713.5%0.8% 45207.5%1.0% 537021.4%1.4% 649610.1%3.6% 752512.4%2.1% 84446.1%1.4% Total373311.0%1.5% Outcomes at Baseline

19. Results - Process Measures BaselineChecklistP-value Objective Airway Evaluation 64.0%77.2%<0.001 Abx at 0-60 Mins Except Dirty Cases 56.1%82.6%<0.001 Verbal Pt/Site Confirmation 54.4%92.3%<0.001 Two IVs /Central Line if EBL500 58.1%63.2%0.32 Pulse Oximeter 93.6%96.8%<0.001 Sponge Count 84.6%94.6%<0.001 All Six Safety Indicators Done 34.2%56.7%<0.001

20. Results – All Sites BaselineChecklistP value Cases 37333955- Death 1.5%0.8%0.003 Any Complication 11.0%7.0%<0.001 SSI 6.2%3.4%<0.001 Unplanned Reoperation 2.4%1.8%0.047

21. Change in Death and Complications by Income Classification Change in Complications Change in Death High Income10.3% -> 7.1%*0.9% -> 0.6% Low and Middle Income 11.7% -> 6.8%*2.1% -> 1.0%* * p<0.05

22. Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229) The checklist was easy to use78.6% The checklist improved operating room safety 79.0% The checklist took a long time to complete18.3% Communication was improved through use of the checklist 84.3% The checklist helped prevent errors in the operating room 78.2% If I were having an operation, I would want the checklist to be used 92.6%

23. A Deeper Look at the Checklist

24. TEAMWORK

25. What is not here?

27. Joint Commission Universal Protocol SCIP Measure

28. WHO

29. Joint Commission Universal Protocol SCIP Measures Joint Commission Universal Protocol

30. WHO

31. Standard of Practice

32. WHO

33. Where is the Checklist Today

34. 3,924 as of 12-8-2010 1,789

35. 3,924 as of 12-8-2010 1,789 Participating Hospitals: 3,924 Actively Using the Checklist: 1,789

37. For More Information : www.safesurg.org www.who.int/safesurgery www.ihi.org Email us at: safesurgery@hsph.harvard.edu