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Follow surgical checklists and take time out, especially in a crisis

BMJ 2011; 343 doi: (Published 30 December 2011) Cite this as: BMJ 2011;343:d8194
  1. D N Hunter,
  2. S J Finney, consultant anaesthetists and intensivists, Royal Brompton Hospital, London SW3 6NP
  1. d.hunter{at}

In June 2008 the World Health Organization launched its second global patient safety challenge, “Safe surgery saves lives” (BMJ 2008;337:a2370, doi:10.1136/bmj.a2370). This three part surgical safety checklist aimed to reduce the incidence of wrong site surgeries and increase the surgical team’s preparedness for anaesthetic and surgical complications.

The following January the UK National Patient Safety Agency issued a patient safety alert that required hospitals to institute this three stage checklist for all surgical patients by February 2010: sign in (before anaesthesia); time out (before incision); sign out (after the operation). Many will remember the hilarity and amazement expressed on Radio 4’s Today programme on the morning of the agency’s announcement that such a simple procedure was not already in use to ensure that the right operation was taking place on the right patient.

Nearly two years later, however, many remain …

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