Safe Surgery and Consent- June 2013

Listed below is the high level evidence on Safe Surgery and Consent produced by NICE, SIGN and NHS based organisations. Also included are the European Society guidelines where available. This list is produced and maintained by HEFT Library Services to support VITAL for Doctors core skills programme developed in the Trust.


HEFT Local Policies

Policy for the Management of correct patient, correct site and correct procedure v3

Director of Operations-Surgery, January 2009. Next review date: September 2009

Consent to Examination or Treatment Policy and Procedure v5

Senior Investigations Manager, January 2011. Next review date: January 2014

Delegated Consent Policy v4.0

Senior Investigations Manager, October 2011. Next review date: October 2013


NICE Guidelines and Pathways

The management of inadvertent perioperative hypothermia in adults

NICE, 2008

Surgical site infection: prevention and treatment of surgical site infection

NICE, 2008

Preoperative Tests: The use of routine preoperative tests for elective surgery

NICE, 2003


Map of Medicine

Map of Medicine (MoM) Use HEFT Athens ID to login to Map of Medicine.

Map of Medicine is a visual representation of evidence-based, practice –informed pathways on various conditions and treatment options. Care of patients in the perioperative period (analgesia, fluid therapy) forms part of the pathways and the evidence links to national guidelines and guidelines from professional bodies related to that specific condition or therapies.


Other National (includes Professional Bodies/Associations) and non-UK Guidelines (with EU)

Standards for Children’s Surgery Royal College of Surgeons, 2013

Guidance for Fellows in implementing surgical safety checklists for radiological procedures Royal College of Radiologists, April 2013

Raising the Standard: a compendium of audit recipes Royal College of Anaesthetists, 3rd edition 2012.

British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients Giftasup Jeremy Powell-Tuck et al. On behalf of BAPEN Medical 2011

The WHO Surgical Safety Checklist: to reduce harm by consistent use of best practice      NPSA, 2011

WHO surgical safety checklist: for maternity cases only     NPSA, 2010

WHO Surgical Safety Checklist: for cataract surgery only   NPSA, 2010

How to guide to the five steps to safer surgery NPSA, 2010

WHO Surgical Safety checklist NPSA, 2009

Surgery in safe hands: priorities and policies 2010 Royal College of Surgeons, September 2009

Reducing harm in perioperative care Patient Safety First Campaign, 2009

Good Practice in Postoperative and Procedural Pain Association of Paediatric Anaesthetists, 2008

WHO surgical safety checklist and implementation manual; World Alliance for Patient Safety, 2008

Safe Surgery Saves Lives, WHO: This page on WHO website provides access to the actual checklist in different languages, tools and resources required to implement it in an organisation.

Correct Site Surgery Royal College of Surgeons and NPSA, 2005

Postoperative Management in Adults: a practical guide to postoperative care for clinical staff Scottish Intercollegiate Guidelines Network, 2004

Post Operative Pain Management Best Practice Statement NHS Quality Improvement Scotland, 2004

Anaesthesia and Peri-Operative Care of the Elderly The Association of Anaesthetists of Great Britain and Ireland, 2001

Good practice in consent implementation guide: consent to examination or treatment Department of Health, 2001

Patient Safety Resources – Surgery This NPSA site highlights guidance on improving patient safety during surgery.


Systematic Reviews – Cochrane Library

Hypertonic saline for peri-operative fluid management

Vivian McAlister1,*, Karen EA Burns2, Tammy Znajda3, Brian Church4

Editorial Group: Cochrane Anaesthesia Group Published Online: 20 JAN 2010


NHS Evidence

Safe Surgery

This website provides a list of health organisations around the world including UK, who have modified the WHO Surgical Checklist and using it within their institutions.

New scientific evidence supports WHO findings: a surgical safety checklist could save hundreds of thousands of lives

At least half a million deaths per year would be preventable with effective implementation of the WHO Surgical Safety Checklist worldwide. These results, obtained in the World Health Organization's 2007-2008 pilot study of its Surgical Safety Checklist have now been confirmed by new studies: the use of checklists significantly reduces surgical morbidity and mortality.

The article it refers to is

de Vries EN, Prins HA, Crolla RMPH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010;363:1928-37


Title: Re: effect of a comprehensive surgical safety system on patient outcomes.

Citation: Journal of Urology, April 2011, vol./is. 185/4(1329-30), 0022-5347;1527-3792 (2011 Apr) Author(s): Babayan RK

Full Text: Available in fulltext at Elsevier; Note: You will need to register (free of charge) with Science Direct the first time you use it.


Title: Effect of a comprehensive surgical safety system on patient outcomes.

Citation: New England Journal of Medicine, November 2010, vol./is. 363/20(1928-37), 0028-4793;1533-4406 (2010 Nov 11) Author(s): 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, Smorenburg SM, Boermeester MA, SURPASS Collaborative Group

Abstract: BACKGROUND: Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway.METHODS: We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals.RESULTS: In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals.CONCLUSIONS: Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care. (Netherlands Trial Register number, NTR1943.).

Full Text: Available in fulltext at EBSCOhost


Further Information:

The following sources have been searched for evidence published in the previous 12 months: HEFT Policies, NHS Evidence, NICE, SIGN, NPSA, Patient Safety First Campaigns, Cochrane Library, Royal College of Surgeons and World Health Organisation. Please contact [email protected]  for any further information.


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