A new 19-question surgical checklist developed by the World Health Organisation has been proven to save lives and reduce errors in a year-long, worldwide trial.

The WHO Safer Surgery Checklist will now be trolled out throughout the NHS in England and Wales on the orders of the National Patient Safety Agency. IT will have to be in place by February 2010. Kevin Cleary, the medical director of the NPSA, said: "It is very difficult for the general public to believe that these checks are not being made already. It is about making them every time, and not assuming that someone else is making them."

Basic questions
The list is a document that has a series of checks for the pre-operative stage, as well as other validations of safe practice during and at the end of surgery. The checks include the questions:
Is this the right patient?
Is this the right limb?
Has the patient had the right drugs?

The year-long global study in eight countries, reported online in the New England Journal of Medicine, found that use of the checklist can reduce the expected number of deaths by over 40 percent and the number of surgical complications by over one-third. The death rate following surgery fell from 1.5 per cent to 0.8 per cent (47 per cent), and the complication rate from 11 per cent to 7 per cent (36 per cent).

The generally accepted rule-of-thumb estimate for people injured by healthcare is about one in ten, but there are very few accurate data.

London pilot
The London pilot study was in St Mary's Hospital in Paddington, where Health Minister Lord Darzi (who is involved in the intitiative as its chair) practices as a colorectal surgeon.

The latest figures on patient safety in Britain, complied by the NPSA, record 129,419 surgical incidents in 2007 when patients were put at risk. Of these, more than 1,000 resulted in severe harm and 271 in death. One patient per day was listed for the wrong operation. In 14 cases, patients about to undergo brain surgery had the incision made on the wrong side of their head.

‘Wrong-site’ surgery, which is listed as a ‘never’ incident (i.e. one that should never happen) in Lord Darzi’s next-stage review on NHS safety and quality, took place more than once a month in 2007. Last year, there was an incident of ‘wrong-site surgery’ at Lord Darzi’s own surgical unit in St Mary’s (though he was not involved.)

Lord Darzi described the NHS’s national adoption of the checklist as "a dream come true. It was in front of us – we all travel and it is in every [aircraft] cockpit. Surgery has become vastly more complex and susceptible to errors. Having a system that reminds the whole team of the 19 items is essential. No single individual, however bright, could ensure it happens every time."