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The checklist places its nineteen items into three "phases" of a surgical procedure: sign-in (before induction of anesthesia, while the patient is still conscious); time-out (with the surgeon present, before skin incision); and sign-out, based on the Joint Commission's Universal Protocol. [15]
In 2009, SCOAP rolled out its most visible initiative—the Surgical Checklist. Modeled after the checklist used by pilots on commercial airlines, this checklist is now in every Washington State hospital. This list assures the entire surgical team reviews each step in the upcoming surgery at the same time and prior to the surgery itself.
The use of the term proceduralist is often used in outlining procedures for ensuring patient safety in any invasive procedure, regardless of the exact type. [3]The proceduralist would be expected to participate and lead a procedural time out, often guided by a checklist such as the WHO Surgical Safety Checklist.
[5] In 2008 Time magazine named Pronovost among the 100 most influential people in the world. [6] That same year, Pronovost was awarded a MacArthur Fellowship. [1] Pronovost's book Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out was released in February 2010. [7]
IPSG.1 Identify Patients Correctly; IPSG.2 Improve Effective Communication; IPSG.3 Improve the Safety of High-Alert Medications; IPSG.4 Ensure Correct-Site, Correct-Procedure, Correct-Patient Surgery
A more advanced checklist would be a schedule, which lays out tasks to be done according to time of day or other factors, or a pre-flight checklist for an airliner, which should ensure a safe take-off. [3] A primary function of a checklist is documentation of the task and auditing against the documentation. [4]
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Critics of this system point out that perioperative mortality may not reflect poor performance but could be caused by other factors, e.g. a high proportion of acute/unplanned surgery, or other patient-related factors. Most hospitals have regular meetings to discuss surgical complications and perioperative mortality.