Surgical safety checklists

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b220 (Published 21 January 2009) Cite this as: BMJ 2009;338:b220

Bias anyone?

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

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]

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



Competing interests:
None declared

Competing interests: No competing interests

27 January 2009
Vashisht Sekar
Clinical Research Fellow in Vascular Surgery
Academic Surgery Unit, University of Manchester M23 9LT