WA Health Surgical Safety Checklist

What is the Surgical Safety Checklist?

The Surgical Safety Checklist was developed in 2008 by the World Health Organisation (WHO) as part of its global Safe Surgery Safes Lives (external site) campaign.

The Checklist is a tool to reduce the rate of surgical error and complications.

It includes a core set of safety checks for use in any operating theatre environment, and incorporates all steps of the Correct Patient, Correct Procedure, Correct Site Policy and Guidelines for WA Health Services (C3 Policy).

Why a Surgical Safety Checklist?

The WA Health C3 Policy was first implemented in 2005 and revised in 2006. It was based on the national Ensuring Correct Patient, Correct Procedure, Correct Site Protocol (national C3 Protocol) endorsed by Australian Health Ministers in 2004.

In 2008, a national review found variation in the implementation of, and compliance with, the national C3 Protocol. In WA, a 2009 audit involving 6 metropolitan hospitals also revealed variation in compliance levels.

In November 2009 Australian Health Ministers endorsed the WHO Surgical Safety Checklist (external site) as the national strategy for surgical safety in Australia, superseding the national C3 Protocol.

Ministers agreed that local versions of the Checklist be implemented in all jurisdictions by 1 July 2011.

OD 0316/11 WA Health Surgical Safety Checklist (external site) was subsequently developed through extensive consultation across WA Health, the private hospital sector and relevant professional associations.

By June 2011, the Checklist had been implemented in all WA operating theatres and procedure rooms where invasive procedures requiring sedation/anaesthesia are performed.

Checklist core principles

The WA Health Checklist is a minimum standard. Sites may adapt it to local requirements by adding extra elements.

The following three principles are to be considered during adaptation:

  • The Checklist is a tool to improve verbal communication among the surgical team in the operating theatre.
  • The Checklist is the final safety check before a procedure is commenced. It is not designed for planning or documenting treatment/care, and does not replace documentation of other pre-surgical processes and procedures.
  • The Checklist should be simple, easy to follow and it should not take longer than 1 minute to complete each section.

Note: As its 3-phase sequence is an important safety feature, adaptation must be limited to adding elements to the template without altering the configuration.

What evidence supports the use of the Checklist?

The Checklist was developed via a comprehensive iterative process and was subject to rigorous international piloting and study.

global trial (external site) of almost 8,000 surgical patients found that its use was associated with reductions in error, complications and mortality rates in both developing and developed countries.1

Evidence is also emerging that use of the Checklist enables better patient flow through theatre, improving efficiency of busy surgical wards, and that it is cost-effective.2

The Checklist is designed to improve safety by focusing on:

  • anaesthetic safety practice
  • ensuring correct site surgery
  • avoiding surgical site infection
  • avoiding venous thromboembolism.

Most importantly the Checklist enhances communication within the surgical team, a critical factor in ensuring safety and quality of care.

The structure is based on the universally accepted sequence of surgical and other invasive procedures.

The Checklist has been widely adopted internationally and is supported by a range of colleges and associations, including:


Refer to OD 0316/11 WA Health Surgical Safety Checklist (external site) for a list of resources including:

  • WA Health Surgical Safety Checklist (landscape)
  • WA Health Surgical Safety Checklist (portrait)
  • Procedural flowchart

The WA Surgical Safety Checklist presentation (PDF 1.87MB) is also available.

The WHO has also produced a number of useful tools and resources (external site) including implementation guides and manuals, a starters’ kit and a PowerPoint presentation.

More information

Quality Improvement and Change Management Unit
Address: 189 Royal Street, East Perth
Phone: 9222 4080
Email: qicm@health.wa.gov.au

Produced by

Quality Improvement and Change Management Unit