Surgical deaths and complications are a global public health problem. The World Health Organization estimates that each year half a million deaths related to surgery could be prevented.1 2 In England and Wales, the National Patient Safety Agency’s national reporting and learning system recorded 129 419 surgery related events in 2007.3 In the United States, the state of Minnesota (with less than 2% of the US population) reported 21 surgeries in the wrong site during one year (October 2007 to October 2008).4 The real situation is probably even worse though, because most safety incidents are not reported.5

In June 2008, WHO launched the Safe Surgery Saves Lives campaign.2 This included a “surgical safety checklist” (www.who.int/patientsafety/safesurgery/en/) to ensure that the entire operating theatre team has a common understanding of the patient and the surgical procedure, and that evidence based interventions such as antibiotic prophylaxis or deep vein thrombosis prophylaxis are reliably given.2 The 19 item checklist is completed in three stages—before induction of anaesthesia (sign in), just before skin incision (time out), and before the patient leaves the operating theatre (sign out). Items on the checklist must be verbally confirmed with the patient and other team members. The WHO Safe Surgery Saves Lives Study Group has published a study of 3733 patients before implementation and …