Is WHO’s surgical safety checklist being hyped?

Yes—David R Urbach, Justin B Dimick

Extraordinary claims, Carl Sagan used to say, require extraordinary evidence. The famed astronomer and science communicator was advocating skepticism around pseudoscientific and paranormal phenomena such as astrology and divination, but it’s reasonable to apply a similarly high standard of scientific evidence to the World Health Organization’s surgical safety checklist.

Checklists, after all, are credited with truly extraordinary power, bordering on the miraculous. A simple, inexpensive intervention can purportedly eliminate half of postoperative deaths.1 The supposed mechanism of this dramatic reduction in mortality is equally fantastic: ensuring that the team members, patient, and procedure are properly identified and confirming that the team has contemplated several processes of care. Such large effects seem implausible, especially considering that most of these processes were already required in modern hospitals and that none has been proved to reduce surgical mortality when applied individually.