A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery

Ann Surg. 2012 Dec;256(6):925-33. doi: 10.1097/SLA.0b013e3182682f27.


Objective: A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.

Background: With the aim of increasing patient safety, checklists have gained growing attention. Information about effectiveness, compliance, and critical factors for implementation is crucial for whether and which of the available instruments to use.

Data sources: Medline including Premedline (OvidSP), Embase, and Cochrane Collaboration Library, hand search, a search of reference lists of key articles, and tables of content.

Study selection: Electronic databases returned 4997 citations, of which 84 articles were chosen for full-text review. Finally, 22 articles were included in this review.

Data extraction: Data relating to care setting, study methods and design, sample population, survey response rate, type of checklist, aim, effectiveness, compliance, attitudes, and critical factors were extracted from the studies. A random effects meta-analysis of effectiveness data was conducted if 2 or more studies reported a specified outcome.

Results: With the use of checklists, the relative risk for mortality is 0.57 [95% confidence interval (CI): 0.42-0.76] and for any complications 0.63 (95% CI: 0.58-0.67). The overall compliance rate ranged from 12% to 100% (mean: 75%) and for the Time Out from 70% to 100% (mean: 91%).

Conclusions: Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Checklist / standards*
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Patient Safety / standards*