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from the American Academy of Orthopaedic Surgeons

Diseases & Conditions



Staying Healthy

Surgical Safety Checklist: Steps Your Healthcare Team Takes

In 2008, the World Health Organization developed a Surgical Safety Checklist. Most hospitals and surgery centers use this important checklist—or a variation of it—to improve surgical safety and outcomes. The list is comprehensive and covers three distinct phases of an operation: before the patient is given anesthesia ("Sign-In"), before the surgeon makes the skin incision ("Time-Out") and before the patient leaves the operating room ("Sign-Out").

Some of these checklist items will be familiar to you because, in preparing for surgery, you have used checklists to share important information about your health with your surgeon and surgical team.

(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.

Confirming Your Identity

During Sign-In, the nurse or anesthesiologist will ask your name to ensure that it matches your medical record and the consent form you signed for surgery.

Planned Surgical Site, Procedure and Surgical Consent

Your surgical team will ask you to confirm everything about your planned surgery, including the incision site and the 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 previously marked by your surgeon is correct.

Medication Allergies

You will be asked to confirm all of your allergies to medications.

Anesthesia Checklist

Your anesthesiologist will ask you several important questions to help them prepare you for anesthesia. Tell your anesthesiologist if you or a member of your family has had an adverse reaction to anesthesia during previous surgeries.

Preparing for a Blood Transfusion

Your surgical team will confirm with you that you have completed specific blood tests, or in some cases, pre-donated blood, in the event a blood transfusion is needed.

Time-Out (Before Skin Incision)

When you are in the operating room, 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.

Reconfirm Surgical Consent

Your surgeon, anesthesiologist, and nurse will review your surgical consent together one final time to make sure that everything is correct.

Review of Surgical, Nursing and Anesthesia Plans

During Time-Out, each member of your surgical team will review with the others his or her 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.

Giving Antibiotics

In many cases, antibiotics are given before surgery to reduce the chance of infection. If it has been determined that antibiotics are needed in your case, the team will confirm that the drugs have been given prior to starting surgery.

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.

Recording 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, and any complications that occurred.

Counting 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.

Labeling of 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.

Discussing a Postoperative Recovery Plan

Finally, the team will discuss all of your needs to make your recovery a smooth one. With your surgery fresh in their minds, they will discuss and record routine 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

March 2019

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.