The Journal of Laryngology & Otology

Main Articles

Achieving flying colours in surgical safety: audit of World Health Organization ‘Surgical Safety Checklist’ compliance

Y Sheenaa1, J M Fishmana1a2 c1, C Nortcliffa1, T Mawbya1, A F Jefferisa3 and N R Bleacha1

a1 Department of Otolaryngology, Wexham Park Hospital, Slough, UK

a2 Institute of Child Health, University College London, UK

a3 Oxford Deanery, Headington, UK


The World Health Organization ‘Surgical Safety Checklist’ has been adopted by UK surgical units following National Patient Safety Agency guidance. Our aim was to assess compliance with our local version of this Checklist.

Otolaryngology trainee doctors prospectively assessed compliance with the local Checklist over a six-week period. A staff educational intervention was implemented and the audit was repeated 12 months later.

A total of 72 cases were assessed. The initial audit found that: 44 per cent of procedures were undocumented at ‘Sign in’; ‘Time out’ was inappropriately interrupted in 39 per cent of cases; the procedure started before Checklist completion in 33 per cent of cases; and the ‘Sign out’ was not read out in 94 per cent of cases and was not fully documented in 42 per cent of cases. Following education, re-audit indicated that overall compliance had improved from 63.7 per cent (±8.9 per cent standard error of the mean) to 90.4 per cent (±2.7 per cent standard error of the mean).

Our completed audit cycle demonstrated a significant improvement in Checklist compliance following educational intervention. We discuss barriers to compliance, as well as strategies for quality improvement, and we call for other surgeons to similarly publish their Checklist experience and assess its impact on surgical outcomes.

(Accepted January 03 2012)

(Online publication August 15 2012)

Key words

  • Otolaryngology;
  • Safety;
  • Audit;
  • World Health Organization;
  • Checklist;
  • Surgical Procedures;
  • Operative


c1 Address for correspondence: Mr Jonathan M Fishman, Wexham Park Hospital, Slough SL2 4HL, UK E-mail:


  Mr J M Fishman takes responsibility for the integrity of the content of the paper

Competing interests: None declared