A new theatre team member asks why the list pauses three times for checklists. Which account of the WHO Surgical Safety Checklist is correct?
- AThe WHO checklist is a well-intentioned but purely bureaucratic exercise, with no published outcome evidence anywhere of any measurable benefit to surgical patients or to theatre teams
- BSign in before induction, time out before incision (team, site, antibiotics, critical events), sign out before leaving (counts, specimens) — with trial-grade mortality evidence
- CTime out occurs after the operation ends
- DCounts and specimen labelling belong to sign in
- EThe checklist applies only to general anaesthetic cases
Show answer and explanation
Correct answer: B
The WHO checklist is the operating theatre's pre-flight discipline, and its three stations map to the moments where preventable harms are born. Sign in (before induction, with the anaesthetist and the awake patient wherever possible): identity, procedure and SITE against the consent form and the surgeon's mark — the wrong-site defence begins here — plus allergies (the anaphylaxis question's prevention arm), anticipated difficult airway or aspiration risk, and expected blood loss over 500 mL triggering access and cross-match readiness. Time out (the full team, before knife-to-skin): introductions by name and role — flattening the hierarchy so the most junior voice can later challenge; verbal re-confirmation of patient, procedure, site; ANTIBIOTIC PROPHYLAXIS within the prior 60 minutes (the checklist is the delivery vehicle for that pharmacokinetic rule); imaging displayed; and the anticipatory declarations — surgeon's critical steps and expected loss, anaesthetist's patient-specific concerns, nursing's sterility and equipment status — that convert individual awareness into team awareness. Sign out (before the patient leaves theatre): counts of instruments, swabs and needles reconciled (the retained-foreign-object barrier — its failure the Never Event of the governance question), specimen labelled and READ ALOUD (mislabelled specimens harm as surely as retained swabs — the pathology-handling question's first step), equipment failures logged, and the recovery and post-operative concerns verbally handed over. The evidence: the multicentre Haynes study nearly halved deaths and complications, with the caveat the exam likes — benefit tracks genuine engagement, not box-ticking — and NatSSIPs embed it, with LocSSIPs extending the same logic to every invasive procedure outside theatre (drains, blocks, endoscopy).
Why the others are wrong: A, C, D and E — mortality evidence exists and is trial-grade; time out precedes incision; counts and labelling are sign out; the checklist covers invasive procedures under any anaesthesia.
Key point: Sign in (identity, site, allergy, airway, blood) before induction; time out (team, confirmation, antibiotics ≤60 min, critical events) before incision; sign out (counts, labelled specimen read aloud, handover) before leaving — a communication tool with mortality evidence, not paperwork, and the carrier of half this bank's prevention rules.
Guidelines: WHO Surgical Safety Checklist (2009) and NatSSIPs 2: sign in, time out and sign out are team communication barriers proven to reduce deaths and complications — effectiveness depends on genuine engagement, with the whole team paused and contributing, not ritual box-ticking.