An overview of the use and implementation of checklists in surgical specialities - a systematic review

Int J Surg. 2014 Dec;12(12):1317-23. doi: 10.1016/j.ijsu.2014.10.031. Epub 2014 Oct 28.


Introduction: Surgical procedures present an immense risk to patients, and adverse patient outcomes are frequently due to substandard non-technical skills amongst surgical staff. The implementation of a 19-item Surgical Safety Checklist, developed by the World Health Organization, is being enforced in operating theatres globally. The objective is to systematically analyze published literature to assess the use of the WHO Surgical Safety Checklist and their impact in on patient safety.

Methods: An English literature search was carried out using MEDLINE, EMBASE and PsycINFO databases. Relevant information was extracted relating to surgical specialities, compliance with the checklist, effects of checklist use on patient outcomes, and staff perceptions of the checklist. Selection was restricted to articles that used the WHO Surgical Safety Checklist.

Results: The literature search found 916 potentially relevant articles, which were narrowed down following an abstract review and a full text review. A final total of 16 studies were identified that observed the use of checklists in various surgical specialties; all surgical specialities (n-10), pediatric surgery (n-2), orthopedic surgery (n-2), otorhinolaryngology surgery (n-2).

Discussion: Surgical checklists have been shown to significantly improve patient outcomes subsequent to surgery, and therefore their use is being widely encouraged and accepted. Continual feedback could be given to maintain high checklist compliance, and thus high patient safety.

Summary: The recent use of checklists in surgery has shown improvements in patient outcomes post-operatively. A review was conducted to establish the impact of the checklist on different surgical specialities.

Keywords: Checklist; Education; Patient outcomes; Patient safety; Surgery.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Checklist / statistics & numerical data*
  • Child
  • Databases, Factual
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Operating Rooms*
  • Patient Safety*
  • Postoperative Period
  • Publishing
  • Risk
  • Specialties, Surgical / statistics & numerical data*
  • World Health Organization