The surgical safety checklist from the anaesthesia side

What it is

The World Health Organization surgical safety checklist is a short list of checks read aloud by the team at three moments of every operation, designed to prevent avoidable harm such as wrong-site surgery, airway disasters, unrecognised allergy, infection and retained items. Sign In happens before induction of anaesthesia, with at least the anaesthesia professional and the nurse: the patient confirms identity, site, procedure and consent; the site is marked; the anaesthesia safety check (machine and drugs) is complete; the pulse oximeter is on the patient and working; and the team states whether the patient has a known allergy, a difficult airway or aspiration risk, or a risk of major blood loss, with equipment, help, intravenous access and blood ready if so. Time Out happens before the skin incision: all team members introduce themselves by name and role, confirm the patient, site and procedure, and review the anticipated critical events, the anaesthesia professional stating any patient-specific concerns; the team confirms that antibiotic prophylaxis has been given within the last 60 minutes when indicated and that essential imaging is displayed. Sign Out happens before the patient leaves the operating room: the nurse confirms the procedure performed, the instrument, sponge and needle counts, specimen labelling and any equipment problems, and the team reviews the key concerns for recovery. In the WHO pilot across hospitals of different income levels, using the checklist was followed by fewer deaths and complications. It works only if done properly, aloud, with everyone stopping, and it may be adapted locally.

Key points

• The checklist is a team tool: it opens communication so that juniors and nurses speak up.
• Wrong patient, wrong site and wrong procedure are 'never events' the checklist is designed to stop.
• A known difficult airway or aspiration risk at Sign In means the equipment and an assistant must be present before induction.
• If major blood loss is expected, there must be adequate intravenous access and blood products available before starting.
• Allergy checks cover drugs, latex, antiseptics and contrast, and drive the choice of antibiotic.

Components

• Sign In (before induction): identity, site, procedure, consent, site marking, anaesthesia safety check, pulse oximeter, allergy, airway and aspiration risk, blood-loss risk.
• Time Out (before incision): introductions, confirmation of patient, site and procedure, critical events from surgeon, anaesthetist and nurse, antibiotic prophylaxis, imaging.
• Sign Out (before leaving the room): procedure name, counts, specimen labels, equipment problems, concerns for recovery.

How it works

• Reading the list aloud makes each item a shared, spoken confirmation rather than an assumption.
• Introductions by name and role make it easier to speak up later during a crisis.
• Sharing anticipated critical events lets each discipline prepare for the others' problems in advance.
• Sign Out turns the end of surgery into a structured handover to the recovery team.

Step by step

1. Before induction, lead or join Sign In with the nurse and the awake patient — identity and consent are best confirmed by the patient.
2. State the anaesthesia safety check, a working pulse oximeter, allergies, airway and aspiration risk and blood-loss risk — each has a specific action.
3. At Time Out, stop all other activity and introduce yourself by name and role — the whole team must be listening.
4. State patient-specific anaesthetic concerns and confirm antibiotic prophylaxis timing — the team can plan and prophylaxis is given in time.
5. At Sign Out, share key concerns for recovery: airway, analgesia, fluids, bleeding — the recovery team needs them.
6. Record completion and report any item that failed — failures are learning points, not blame.

The three phases and what the anaesthesia professional contributes

Next step

• Do not induce anaesthesia until Sign In is complete, unless an emergency makes delay more dangerous.
• If an item cannot be confirmed (consent, site, airway equipment, blood), stop and resolve it, calling a senior if needed.
• Give antibiotic prophylaxis at the right time and repeat it in long operations or major blood loss according to local protocol.
• Report checklist failures and near-misses through the hospital safety reporting system.

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Elsewhere in DurgiPedia

• The WHO surgical safety checklist
• Handoff and SBAR communication
• Patient safety in Colombia: the policy and its instructional packages
• Medical error: disclosure and apology

Connections

← All of anaesthesia

Educational content; it does not replace supervised training, your institution's protocols or the anaesthetist's or intensivist's decision. It contains no doses and no ventilator or infusion settings.

Sources: Implementation manual WHO surgical safety checklist 2009: Safe surgery saves lives (World Health Organization (WHO), 2009).

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Representative model, for educational purposes only.