Treatment
Surgical Safety Checklist: Steps Your Healthcare Team Takes
Just as an airline pilot and crew use a safety checklist to ensure a plane's safety before takeoff, orthopaedic surgeons and surgical teams use a checklist to keep surgical patients safe.
The World Health Organization developed a Surgical Safety Checklist in 2018 that most hospitals and surgery centers use today. This comprehensive list is divided into three sub-checklists to cover the three phases of an operation:
- Before the patient is given anesthesia ("Sign-In")
- Before the surgeon makes the skin incision ("Time-Out")
- Before the patient leaves the operating room ("Sign-Out")
Some of these checklist items and tasks may be familiar to you because your healthcare team asks you to participate. Other checklist items and tasks occur "behind the scenes"; you may not be aware of them, but they are essential to ensuring your safety and well-being.
Checklist 1: Sign-In (Before Anesthesia)
Your surgical team will review the Sign-In checklist before you go into the operating room. As your team goes through each step on the list, do not hesitate to speak up if you think there has been an error or if you would like clarification.
Your Identity
During Sign-In, the surgical staff will ask your name to ensure that it matches your medical record and the informed surgical consent document you signed.
Surgical Site, Procedure, and Surgical Consent
Your surgical team will ask you to confirm everything about your planned surgery, including the location and type of surgery planned. You will be asked to verify that everything you said is the same information that is on the surgical consent form.
Proper Surgical Site Marking
You will be asked to verify that the incision site (location) marked by your surgeon is correct. In orthopaedic surgery, the care team encourages a specific confirmation check that the site mark is correct for:
- Body side (right or left) where the surgery is to be performed. For instance, you are having rotator cuff repair in your left shoulder, or having your right knee replaced.
- Individual fingers or toes, if relevant. For instance, you are having surgery to repair a fracture in your left ring finger.
The surgeon may also be able to estimate the exact side as well as the size of the incision at that time.
Medications and Allergies
You will be asked to confirm all of your allergies to medications.
Anesthesia
Your anesthesiologist will ask you several important questions to help them prepare you for anesthesia and keep you safe during anesthesia. Tell your anesthesiologist if you or a member of your family has had an allergy or bad reaction to anesthesia during any previous surgeries.
Preparing for a Blood Transfusion
Your surgical team will confirm with you that you have completed specific blood tests.
You may be asked about your preferences regarding blood transfusion during surgery, in case there is an emergency during surgery that requires transfusion of blood or blood products.
Checklist 2: Time-Out (Before Skin Incision)
Your surgical team will use the Time-Out checklist to share important information about you and your upcoming surgery. During this time, the team will be very quiet and attentive to make sure that everything is correct.
Team Member Introductions
To improve communication during your surgery, all the members of your surgical team will introduce themselves to each other by name and role.
Surgical Consent Reconfirmed
Your surgeon, anesthesiologist, and nurse will review your surgical consent together one final time to make sure that everything is correct.
Surgical, Nursing, and Anesthesia Plans
During Time-Out, each member of your surgical team will review with the others their respective plan for your procedure. For example, the surgeon will review the surgical plan with the nurse, and make sure all is ready, including any devices or implants, or special considerations.
The nursing team will review the nursing plan — double-checking the planned procedure and needed instruments, equipment, implants, and anything special you might need during your surgery.
Also during this time, the anesthesiologist will review the anesthesia plan to make sure everything is ready for you, and ensure that special equipment is available, if needed.
Antibiotics and Other Pre-Medications Given
In many cases, antibiotics are given before surgery to reduce the chance of infection. In other cases, inflammation reducers are given just before skin incision.
If it has been determined that antibiotics or inflammation reducers are needed in your case, the team will confirm that the drugs have been given before starting surgery.
Checklist 3: Sign-Out (Before Leaving the Operating Room)
After your surgery is finished but before you leave the operating room, your surgical team will use the Sign-Out checklist to complete medical record documentation and to address anything that could be made better for future surgical cases.
Record Your Procedure
The nurse will check with the surgeon to make sure that the specific details of your procedure are clearly documented in your medical record. This documentation could include:
- The operation performed
- The anesthetic used
- Types of implants
- Blood loss
- Any complications that occurred
Count the Instruments, Needles, and Sponges
To minimize the chance of leaving any surgical items in your wound, the team will check to make sure that all instruments are accounted for, and that needle and sponge counts are correct.
Label Specimens
If tissue or fluid samples were collected during your procedure for later testing, your team will check to make sure each specimen is labeled correctly with your name and the test to be run before it is sent to the lab.
Equipment Check
After your surgery is completed, your operating team will inspect all the equipment used to make sure that it is processed properly so that it is available for future cases.
Discuss a Postoperative Recovery Plan
Finally, the team will discuss all of your needs to make sure your recovery goes smoothly. With your surgery fresh in their minds, they will discuss and record routine (standard) or special orders to identify and minimize any potential problems that may occur. All of this is done with the goal of giving you the best chance possible to fully recover.
To assist doctors in preventing surgical site infections, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Plain Language Summary - Clinical Practice Guideline - Surgical Site Infections
Last Reviewed
January 2025
Contributed and/or Updated by
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.