As noted in http://content.nejm.org/cgi/content/full/NEJMsa0810119, "A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population:

This checklist, going beyond a simple Time Out, is from World Health Organization's Safe Surgery Saves Lives program. It was tested around the world last year. Result: "The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P

There was a good discussion of it by surgeons (http://www.washingtonpost.com/wp-dyn/content/article/2009/01/14/AR2009011402831.html, including how the checklist helped ensure "every step, every time" occurred more often but not always...

Are you using it, or some other pre-to-post-surgery checklist? How is it being accepted by the circulator, the scrub, the surgeon, the anesth.? Is this like Time Out, where it takes a really gutsy circulator to stand up to intimidation for it to work?

We have implemented a checklist for surgical patients. However, we use/call it a "Passport to Surgery". This is initiated either in same day surgery or on the floor if the patient is in-house. It's purpose is to make sure everything is ready for the patient up to time of going TO surgery. Elements include making sure all MD orders have been done, permit has been completed and signed, all labs have been completed and are printed and available on the chart, blood if ordered is available in the blood bank, jewelry has been removed, clothing removed, dentures removed, antibiotics have been ordered, or if an in-house patient the time the last antibiotic was given, a history and physical is available in hard copy on the chart and it is timely, etc. Our circulators interview the patient before ever going to the operating room so that all information can be confirmed and any questions answered. Also, the MD must initial the side (if applicable) before the patient is taken back. When we take the patient to the operating room, we introduce them, tell which surgeon and procedure they are having, any allergies, and whether antibiotics have been ordered and given. There is also a final time out after the surgeon has scrubbed and everyone is present in the room, confirming all of these same elements. This is actually documented in our OR records verifying agreement between surgeon, anesthesia, circulator, surgical technologist and any other such as perfusion or implant representative.

The only real problem we have with compliance is making sure the H & P is timely, the antibiotics have been ordered, or the physician marks the site before going to the OR. If those elements are not done, we don't roll. They may gripe and grumble, but they're just wasting time. They do come take care of their responsibilities because they know it's the way to get their surgery under way.