Institutional members access full text with Ovid®

Share this article on:

A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery

Borchard, Annegret MPH*; Schwappach, David L. B. PhD, MPH*,†; Barbir, Aline MPH; Bezzola, Paula MPH*

doi: 10.1097/SLA.0b013e3182682f27
Systematic Reviews and Meta Analyses

Objective: A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.

Background: With the aim of increasing patient safety, checklists have gained growing attention. Information about effectiveness, compliance, and critical factors for implementation is crucial for whether and which of the available instruments to use.

Data Sources: Medline including Premedline (OvidSP), Embase, and Cochrane Collaboration Library, hand search, a search of reference lists of key articles, and tables of content.

Study Selection: Electronic databases returned 4997 citations, of which 84 articles were chosen for full-text review. Finally, 22 articles were included in this review.

Data Extraction: Data relating to care setting, study methods and design, sample population, survey response rate, type of checklist, aim, effectiveness, compliance, attitudes, and critical factors were extracted from the studies. A random effects meta-analysis of effectiveness data was conducted if 2 or more studies reported a specified outcome.

Results: With the use of checklists, the relative risk for mortality is 0.57 [95% confidence interval (CI): 0.42–0.76] and for any complications 0.63 (95% CI: 0.58–0.67). The overall compliance rate ranged from 12% to 100% (mean: 75%) and for the Time Out from 70% to 100% (mean: 91%).

Conclusions: Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed.

Supplemental Digital Content is Available in the Text.This systematic review provides the current evidence regarding the effectiveness, compliance, and critical factors for successful implementation of a surgical safety checklist.

*Swiss Patient Safety Foundation, Zurich

Institute of Social and Preventive Medicine (ISPM), University of Bern

Institute of Social and Preventive Medicine (ISPM), University of Zurich, Switzerland.

Reprints: David L. B. Schwappach, PhD, MPH, Swiss Patient Safety Foundation, Asylstrasse 77. 8032 Zuerich, Switzerland. E-mail:

Disclosure: D.L.B.S. and P.B. received grants from the Swiss Surgical Association (FMCH) and the Federal Office of Public Health (BAG). The funding sources had no influence on study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. The views expressed and any errors or omissions are the sole responsibility of the authors. The authors have no conflicts of interest to declare.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2012 Lippincott Williams & Wilkins, Inc.