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WHO cares? Safety checklists in echocardiography


The number of potentially preventable medical errors that occur has been steadily increasing. These are a significant cause of patient morbidity, can lead to life-threatening complications and may result in a significant financial burden on health care. Effective communication and team working reduce errors and serious incidents. In particular the implementation of the World Health Organisation (WHO) Safe Surgery Checklist has been shown to reduce in-hospital mortality, postoperative complications and the incidence of surgical site infection. However an increasing number of complex medical procedures and interventions are being performed outside of the theatre environment. The lessons learnt from the surgical setting are relevant to other procedures performed in other areas. For the echocardiographer, transoesophageal echocardiography (TOE) is one such procedure in which there is the potential for medical errors that may result in patient harm. This risk is increased if patient sedation is being administered. The British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists have developed a procedure specific checklist to facilitate the use of checklists into routine practice. In this article we discuss the evolution of the WHO safety checklist and explore its relevance to TOE.


  1. Panesar SS, Cleary K, Sheikh A, & Donaldson L 2009 The WHO checklist: a global tool to prevent errors in surgery. Patient Safety in Surgery 3 9 (doi:10.1186/1754-9493-3-9)

    Article  PubMed  PubMed Central  Google Scholar 

  2. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, et al. 2009 A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine 360 491–499. (doi:10.1056/NEJMsa0810119)

    Article  CAS  PubMed  Google Scholar 

  3. World Health Organisation. World Alliance for Patient Safety, WHO guidelines for safe surgery. 2008:

    Google Scholar 

  4. Wilson I, & Walker I 2009 The WHO Surgical Safety Checklist: the evidence. Journal of Perioperative Practice 19 362–364.

    Article  PubMed  Google Scholar 

  5. de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, et al. 2010 Effect of a comprehensive surgical safety system on patient outcomes. New England Journal of Medicine 363 1928–1937. (doi:10.1056/NEJMsa0911535)

    Article  PubMed  Google Scholar 

  6. Matharoo M, Thomas-Gibson S, Haycock A, & Sevdalis N 2014 Implementation of an endoscopy safety checklist. Frontline Gastroenterology 5 260–265. (doi:10.1136/flgastro-2013-100393)

    Article  CAS  PubMed  Google Scholar 

  7. van Klei WA, Hoff RG, van Aarnhem EE, Simmermacher RK, Regli LP, Kappen TH, van Wolfswinkel L, Kalkman CJ, Buhre WF, & Peelen LM 2012 Effects of the introduction of the WHO "Surgical Safety Checklist" on in-hospital mortality: a cohort study. Annals of Surgery 255 44–49. (doi:10.1097/SLA.0b013e31823779ae.)

    Article  PubMed  Google Scholar 

  8. Clark SC, Dunning J, Alfieri OR, Elia S, Hamilton LR, Kappetein AP, Lockowandt U, Sarris GE, Kolh PH, Clinical Guidelines Committee of the European Association for Cardio-Thoracic Surgery 2012 EACTS guidelines for the use of patient safety checklists. European Journal of Cardio-Thoracic Surgery 41 993–1004. (doi:10.1093/ejcts/ezs009)

    Article  PubMed  Google Scholar 

  9. Pickering SP, Robertson ER, Griffin D, Hadi M, Morgan LJ, Catchpole KC, New S, Collins G, & McCulloch P 2013 Compliance and use of the World Health Organization checklist in UK operating theatres. British Journal of Surgery 100 1664–1670. (doi:10.1002/bjs.9305)

    Article  CAS  PubMed  Google Scholar 

  10. Mahajan RP 2011 The WHO surgical checklist. Best Practice & Research. Clinical Anaesthesiology 25 161–168. (doi:10.1016/j.bpa.2011.02.002)

    Article  Google Scholar 

  11. Cahill TJ, Clarke SC, Simpson IA, & Stables RH 2015 A patient safety checklist for the cardiac catheterisation laboratory. Heart 101 91–93. (doi:10.1136/heartjnl-2014-306927)

    Article  CAS  PubMed  Google Scholar 

  12. Sharma V, Alderton S, McNamara H, Steeds R, Bradlow W, Chenzbraun A, Oxborough D, Matthew T, Jones R, Wheeler R, et al. 2015 A safety checklist for transoesophageal echocardiography from the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists. Echo Research and Practice 2 G25–G27. (doi:10.1530/ERP-15-0035)

    Article  PubMed  PubMed Central  Google Scholar 

  13. NHS England, Patient Safety Domain Team 2013 The never events list; 2013/14 update;

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Quarterman, C., Fletcher, N. & Sharma, V. WHO cares? Safety checklists in echocardiography. Echo Res Pract 2, E9–E12 (2015).

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