The World Health Organization (WHO) has published a Surgical Safety Checklist.


(1) sign in - before induction of anesthesia

(2) time out - just before starting procedure

(3) sign out - before leaving the operating theater


Each item is to be read out loud.


Sign in:

(1) Has the patient confirmed her/his identity?

(2) Has the patient confirmed the procedure and surgical site?

(3) Has consent been given and documented?

(4) Is the surgical site marked?

(5) Has the anesthesia equipment been checked?

(6) Have the anesthesia medications been checked?

(7) Have the patient's allergies been documented?

(8) Is the patient at risk for a difficult airway or aspiration?

(9) Is excessive blood loss expected (> 500 mL for adult, > 7 mL/kg for pediatric patient)?

(10) Is a pulse oximeter in place and functioning appropriately?


Management of a difficult airway may require special equipment and/or assistance be available. Adequate intravenous access should be available if fluids or blood will need to be administered.


Time out:

(1) Have all team members been introduced by name and role?

(2) Has the patient's name been confirmed?

(3) Have the procedure, site and position been confirmed?

(4) What is the expected blood loss?

(5) Are all special equipment, instruments and supplies available?

(6) What is the expected length of the procedure?

(7) Are there any critical or unexpected steps expected during the procedure?

(8) Are there any patient-specific concerns related to anesthesia?

(9) What is the ASA grade?

(10) Is monitoring equipment for anesthesia available?

(11) Is blood or any other requirement available?

(12) Has the sterility of the instrumentation been confirmed?

(13) Are there any equipment issues or concerns?

(14) Has antibiotic prophylaxis been given within the past 60 minutes?

(15) Has provision been made for patient warming if needed?

(16) Has hair removal and skin preparation been performed appropriately?

(17) Have steps been taken to maintain glycemic control?

(18) Has venous thromboembolic prophylaxis been planned?

(19) Is essential imaging displayed?


Sign out:

(1) Has the name of the procedure been recorded?

(2) Has the instrument, sponge and sharp/needle count been confirmed?

(3) Have all specimens been properly labeled and designated?

(4) Have any equipment problems been identified for followup?

(5) Are there any specific concerns for recovery or management of the patient?

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