Surgical safety checklists

Bias anyone?

27 January 2009

The WHO team should be commended on their efforts to improve patient safety. A simple and effective tool, the study showed a significant decrease in mortality and morbidity associated with surgery in countries representing the various WHO regions, especially so in lower income countries (1). However, the study is not without its limitations.

The authors of the original study correctly stated their difficulty in 'disentangling' the Hawthorne effect ie. the effect of improved performance in one being observed.(1) To seek more information on the study and ways to implement the checklist, I accessed the safe surgery webpage (2) on the WHO website which hails one to 'go after' the 'low hanging fruit' (those most suited to implement such research into their own practice).(3)

By targeting those who are keen on implementing these checklists, the WHO might possibly perpetuate an Investigator bias into subsequent studies.

If such limitations are overcome in randomised controlled trials, the safety checklist could possibly herald a new era in patient safety especially in lower income countries.

1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009 Jan 14 [Epub ahead of print] doi:10.1056/NEJMsa0810119.

2. http://www.who.int/patientsafety/safesurgery/en/

3. http://www.who.int/patientsafety/safesurgery/faq_introduction/en/index1....

Competing interests: None declared

Competing interests: None declared

Vashisht Sekar, Clinical Research Fellow in Vascular Surgery

Academic Surgery Unit, University of Manchester M23 9LT

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