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Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 0


Additional Professor, Gynecological Oncology & Editorial Secretary JIGIMS

Date of Web Publication12-Feb-2016

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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Pankaj S. Editorial. J Indira Gandhi Inst Med Sci 2016;2:0

How to cite this URL:
Pankaj S. Editorial. J Indira Gandhi Inst Med Sci [serial online] 2016 [cited 2022 Oct 5];2:0. Available from: http://www.jigims.co.in/text.asp?2016/2/1/0/303376

The rolling wheel of time has again brought me to an amalgamated crossroads, where past is withering away carving out future moments…. en-route present……..seems, soon enough…. as now…. we are presenting the third issue of this journal before you!

Not a landmark in the life cycle of an institute, but obviously for an editor !! We are witness to the times on the eternal canvas of life, when change is too fast ……. everything … from perception to practice …. is through a rapid flux. The onus now on the health professional is not only to deliver healthcare but safe and quality healthcare, to an aware populace, as compared from before ! IGIMS being an indelible imprint on the medical landscape of Bihar cannot just be a mute spectator. We ought to get up and get going. Apart from being anything else, I am a surgeon first & then, it becomes even more imperative for me to do something significant.

In the said context, I wish to share with you all that on 25th June 2008, the World Health Organization (WHO) launched the Second Global Patient Safety Challenge: Safe Surgery Saves Lives initiative and introduced the “WHO Surgical Safety Checklist.” The checklist is designed to catch omissions in the actions supporting an operation before the patient suffers harm. The “WHO Surgical Safety Checklist” was developed by the World Alliance for Patient Safety under the direction of Atul Gawande, MD, FACS, of Harvard University. It was piloted in eight hospitals on four continents, including the University of Washington. It has been endorsed by more than 200 organizations, including the American College of Surgeons, American Society of Anesthesiologists, Association of perioperative Registered Nurses, American Academy of Orthopaedic Surgeons, American College of Obstetricians and Gynecologists, American Academy of Otolaryngology-Head and Neck Surgery, North American Spine Society, and Council on Surgical and Perioperative Safety. Dr. Gawande pointed out that the endorsements covered nations providing surgical care to 75% of the world population. The checklist has three parts: (1) Sign In, (2) Time Out, and (3) Sign Out. Each part has five to seven itemsforthe operative team to review. Dr. Gawande pointed out that 234 million operations are done in the world each year-1 for every 25 people. About 7 million of these operations result in complications. About half of the complications are preventable. The surgical safety checklist is designed to reduce these preventable complications.

Dr. Gawande stated that before using a checklist, the eight pilot hospitals had a complication rate of 11%, with 64% of patients failing to get one or more of six safe surgical practices. After using the surgical safety checklist for the first 1,000 patients, the percentage of patients not getting one or more of six safe surgical practices dropped in half to 32%.

The Sign In consists of

  • verification of the operative documents with the patient,
  • checking that the site has been marked if indicated,
  • completion of an anesthesia safety check,
  • confirmation of pulse oximetry monitoring,
  • documentation of allergies,
  • assessment of airway, and
  • confirmation of the adequacy of intravenous access.

The Time Out consists of

  • introduction of the team members;
  • confirmation of the site;
  • review of critical steps by the surgeon, anesthesia professional, and nurse;
  • confirmation of antibiotic use; and
  • confirmation of images.

The Sign Out consists of

  • confirmation of the procedure,
  • confirmation of the counts,
  • confirmation of the specimen label,
  • mention of equipment problems, and
  • plan for patient recovery.

Each of the eight pilot hospitals recounted its experience. Many of the hospitals described an initial resistance, followed by a realization that the checklist not only identified missing elements, but also reinforced teamwork. Many said that each of the three parts of the checklist took less than one minute to complete. Almost every site modified the checklist slightly, while maintaining the prescribed elements. For instance, the Canadian site added prophylaxis for deep venous thrombosis to the checklist. Within months, the members of the operating teams felt the checklist was essential.

As Registrar of the institute, I feel it’s my responsibility to take one step forward in this direction. It’s always better to light a candle than to curse the darkness. On behalf of the Editor, Prof Mahendra Singh and as a surgeon, I encourage all operating room in IGIMS to incorporate the “WHO Surgical Safety Checklist” into their workflow and track the impact. I dedicate this editorial to the cause of patient safety and look forward to administrative support in this regard from our learned Director, Prof N R Biswas, who has always been right there for every futuristic step.

For more information about the “WHO Surgical Safety Checklist,” please go to the WHO Web site (http://www.who.int/patientsafety/safesurgery/en/) or contact me. For those who are interested, WHO has copies of the checklist and an implementation manual available at http://www.who.int/patientsafety/safesurgery/tools_resources/technical/en/index.html.

I acknowledge the selfless sincere work of all the members of the editorial team and support staff with special mention of Mr. Chandan Kumar for editing and formatting of the journal.

With malice towards none & charity for all ……


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