Surgical Checklist Initiative

SCOAP has produced a safety and quality checklist for the OR which is rolling out in all hospitals in Washington State. The checklist is used at the start of surgery as part of an extended “time out” and after surgery as part of a debriefing. The SCOAP OR Surgical Checklist, which goes beyond the JCAHO “time out” concept, guarantees that vital steps to a successful procedure are carried out and reinforces a culture of patient safety. The SCOAP checklist is an active way of controlling the variability that exists in surgical care, thus creating a system that delivers safer surgery.

In January 2009, a coalition of healthcare stakeholders supported the initiative’s goal of having a SCOAP checklist in every OR at every hospital in Washington State by the end of the year. The coalition members set the goal of getting a Surgical Checklist into every OR in Washington State by January 2010, leading to media attention across the state along with a proclamation from the governor.

Congratulations to Washington Hospitals!

By March 2010, SCOAP and the Washington State Hospital Association announced that 100% of Washington State hospitals (plus some of the free-standing surgery centers) had either implemented a standardized surgical checklist or were in the process of doing so.

Why should hospitals/surgeons participate in the SCOAP Surgical Checklist?

“I am a huge fan of SCOAP.”Atul Gawande, best-selling author and surgeon:

We in surgery have been slow to take collective responsibility for insuring basic standards of good care are followed everywhere surgery is done. Our WHO safe surgery checklist has been proved to reduce deaths and complications by more than a third. But it makes no difference if there is no community participation to use it and measure the results. SCOAP is doing this work. I wholeheartedly endorse its adaptation of the checklist and view the SCOAP initiative to take it statewide as an example for our whole nation.

In this New Yorker article, Gawande illustrates the complexity of intensive care and profiles Peter Pronovost, the Johns Hopkins intensivist and safety leader whose efforts to standardize safety practices led to remarkable reductions in ICU harm in Michigan hospitals.

The article goes on to a broader discussion of how checklists and decision support have reduced errors and transformed safety in critical care. Gawande also reflects on how implementation of standardized approaches often conflicts with the traditional physician culture, which prizes individual expertise over all else. –Click here to listen to a related NPR Interview

SCOAP Surgical Checklist Initiative
Landmark New England Journal of Medicine study shows how surgical checklists save lives

The SCOAP Surgical Checklist was adapted for use in the United States by SCOAP and surgeons at the University of Washington who pilot tested the WHO checklist as featured in The New England Journal of Medicine.


How a simple checklist can dramatically reduce medical errors. Pronovost PJ. On Call. IHI Open School for Health Professionals. November 3, 2008.

This new audio program features Peter Pronovost discussing his experience with checklist development and how it might be applied to support other quality improvement targets.