The effect of the WHO Surgical Safety Checklist on complication rate and communication

Dtsch Arztebl Int. 2012 Oct;109(42):695-701. doi: 10.3238/arztebl.2012.0695. Epub 2012 Oct 19.


Background: In 2009, the World Health Organisation issued a worldwide recommendation for the use of its Surgical Safety Checklist in all operative procedures. In this review, we present the available data on the implementation of this checklist and its effect on perioperative morbidity and mortality and on operating-room safety culture. We also survey the experience with the checklist to date and give some recommendations for its practical implementation.

Methods: We reviewed pertinent original publications retrieved by a selective search in the PubMed and Medline databases on the search term "Surgical Safety Checklist". All papers published before February 2012 were analyzed.

Results: The 20 studies that we analyzed included a single prospective randomized trial concerning the effect of the WHO checklist on safety-related behavior in the operating room. The two surgical outcome studies documented a relative improvement of perioperative mortality by 47% in one study (from 56 in 3733 cases [1.5%] to 32 in 3955 cases [0.8%]) and by 62% in the other (from 31 in 842 cases [3.7%] to 13 in 908 cases [1.4%]), as well as a relative improvement of perioperative morbidity by 36% in one study (from 411 in 3733 cases [11.0%] to 288 in 3,955 cases [7.3%]) and by 37% in the other (from 151 in 842 cases [17.9%] to 102 in 908 cases [11.2%]). Improved interdisciplinary communication was also found. Factors that aided effective use of the checklist included exemplary implementation by team leaders and structured training.

Conclusion: These results support the WHO's recommendation to use the Surgical Safety Checklist in all operative procedures. The checklist should be understood not merely as a list of items to be checked off, but as an instrument for the improvement of communication, teamwork, and safety culture in the operating room, and it should be implemented accordingly.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Checklist / standards
  • Checklist / statistics & numerical data*
  • Germany
  • Humans
  • Incidence
  • Interdisciplinary Communication*
  • Internationality
  • Medical Errors / mortality*
  • Medical Errors / prevention & control*
  • Operating Rooms / standards
  • Operating Rooms / statistics & numerical data*
  • Patient Safety / statistics & numerical data
  • Postoperative Complications / mortality*
  • Postoperative Complications / prevention & control*
  • Risk Assessment
  • Safety Management / statistics & numerical data
  • Survival Analysis
  • Survival Rate
  • World Health Organization