Health care is complex, with several interdisciplinary elements, incredibly unpredictable and at high risk of hazard. Healthcare environments are complex and tightly coupled systems that have proven to be error-prone . Patients expect to be reasonably safe when under medical supervision . In 1999, the US based, Institute of Medicine report, To Err is Human, claimed that between 44.000 and 98.000 patients in the US die every year from preventable adverse events. However regardless of an ongoing push for drastic improvement of the safety culture in healthcare, medical errors continue to occur at unacceptable rates . The rising cost of health care is given progressively more importance worldwide. A major factor affecting hospital cost is complications following surgery . Surgical care is an integral part of health care throughout the world, with an estimated 234 million operations performed annually . Surgical complications are a considerable cause of death and disability around the world. The World Bank reported that in 2002, an estimated 164 million disability-adjusted life years, representing 11% of the entire disease burden, were attributable to surgically treatable conditions . Surgical complications are devastating to patients, costly to health care systems, and often preventable, though their prevention typically requires a change in systems and individual behavior.

1. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
Predictive Value of Surgical Safety Checklist and Operating Room (OR) briefings in
Dentistry.
Author: Dr. Shoeb Ahmed Ilyas BDS, MPH, EMSRHS, M.Phil. (HHSM), MHRM, MS (PSY), MS
(BIOTECH), PGDMLE, FHTA.
Health Care Quality Management Consultant
Ruby Med Plus, Telangana State, India.
Health care is complex, with several interdisciplinary elements, incredibly unpredictable and at
high risk of hazard. Healthcare environments are complex and tightly coupled systems that have
proven to be error-pronei
. Patients expect to be reasonably safe when under medical
supervisionii
. In 1999, the US based, Institute of Medicine report, To Err is Human, claimed that
between 44.000 and 98.000 patients in the US die every year from preventable adverse events.
However regardless of an ongoing push for drastic improvement of the safety culture in
healthcare, medical errors continue to occur at unacceptable ratesiii
.
The rising cost of health care is given progressively more importance worldwide. A major factor
affecting hospital cost is complications following surgeryiv
. Surgical care is an integral part of
health care throughout the world, with an estimated 234 million operations performed annuallyv
.
Surgical complications are a considerable cause of death and disability around the world. The
World Bank reported that in 2002, an estimated 164 million disability-adjusted life years,
representing 11% of the entire disease burden, were attributable to surgically treatable

2. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
conditionsvi
. Surgical complications are devastating to patients, costly to health care systems, and
often preventable, though their prevention typically requires a change in systems and individual
behavior.
Safety is a critical aspect of the quality of care in a complex hospital setting. Wrong-site, wrong-
procedure and wrong patient surgeries are catastrophic events for patients, medical caregivers
and institutionsvii
. Given that complications are, in general, associated with increased length of
stay and cost, it is possible that such a reduction in morbidity rate will generate cost savings that
can offset the expense of prospective data collectionviii
. Data suggest that at least half of all
surgical complications are avoidableix
. Previous efforts to implement practices designed to
reduce surgical site infections or anesthesia-related mishaps have been shown to reduce
complications significantlyx
.
The Rationale of Surgical Safety Checklist in Health care-
Documented variation in the quality of medical care, especially for surgical procedures, has led
to enthusiasm for systematic quality improvement programsxi
.With extensive implementation;
such systems might potentially reduce morbidity and mortality across big groups of Health care
providers. In 2004, The Joint Commission introduced the mandatory Universal Protocol to all
accredited hospitals as a means of preventing wrong surgeries or surgeries on the wrong patient
or wrong site—sentinel events that have proven to be a direct result of communication failuresxii
.
In 2008, the World Health Organization (WHO) published guidelines identifying multiple
recommended practices to ensure the safety of surgical patients worldwide. The Safe Surgery
Saves Lives Study Group at the World Health Organization (WHO) published the results of
instituting a perioperative surgical safety checklistxiii
. The use of this checklist in eight hospitals
around the world was associated with a reduction in major complications from 11.0% before
introduction of the checklist to 7.0% afterward.

3. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
Figure- 1 shows WHO Surgical safety checklist.
The results of a global pilot of the WHO checklistxiv
, demonstrated reliable performance
Of a series of safety checks, this could reduce surgical mortality and morbidity. Most
Commonly reported benefits of implementing the checklist were improved teamwork, safety,
more near misses captured smoother / quicker procedures and improved staff morale. The
two most commonly reported challenges for implementation of safety checklist are lack of
Clinical engagement, and a tendency to see the Checklist as a ‘tick box exercise’, rather than as a
tool to enhance communication and teamwork, hence adoption of safety checklist requires
Changes in systems and behavior of individual surgical teams.

4. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
The Operating Room (Operating Room (OR)) briefings improves Surgical Outcomes -
The purpose of the Operating Room (Operating Room (OR)) briefings is to formulate and share
the operative plan, to promote teamwork, to alleviate hazards to patients, to reduce preventable
harm, and to ensure all required equipment is available. The Operating Room (OR) briefing
checklist, named as Operating Room (OR) Briefing 5, enhances communication among
Operating Room (OR) team members and improve patient safety (Table-1). The 2-minute
Operating Room (OR) briefing familiarizes surgical team with each other and with the operative
plan through 3 critical components:
1. Each member of the Operating Room (OR) team states his or her name and role;
2. The surgeon leads the “timeout” to identify critical components of the operation,
including the surgical site.
3. Surgical care teams discuss and mitigate potential safety hazardsxv
.
What are the names and roles of the team members?
Is the correct patient/procedure confirmed? (TIME-OUT)
Have antibiotics been given? (if appropriate)
What are the critical steps of the procedure?
What are the potential problems for the case?
Reviewed by nursing, anesthesia, and surgery.
Table- 1 showing Operating Room Briefing 5.
The philosophy of ensuring the correct identity of the patient and site through preoperative site
marking, oral confirmation in the operating room, and other measures proved better surgical
outcomes and reduced cost of surgical complications. A “surgical time-out” or “surgical pause,”
introduced on 1st
June, 2006, involves the Operating Room (OR) team convening after the
administration of anesthetic but before skin incision for each patient to reverify the patient,
procedure and site of surgery.

5. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
Figure- 2 shows 5 steps for safer surgery (Adapted from Patient Safety First)
The Hospital for Sick Children (Sick Kids) in Toronto, Ont., initiated two Operating Room
safety initiatives: a “07:35 huddle” (preoperative Operating Room (OR) briefing) and a “surgical
time-out” (perioperative Operating Room (OR) briefing).
The above tools provide Operating Room (OR) teams with a structured and standardized
approach to increase interdisciplinary communication in the Operating Room (OR), thereby
promoting teamwork and creating a culture of safety. The expectation is that Operating Room
(OR) team members are encouraged to become more proactive about patient safety, speak up
when an identified problem in patient care is discovered and improve patient outcomes.ii
In all
Dental Operating Room (OR)s there must be 1-page laminated poster highlighting the key
components of huddles and time-outs to facilitate and guide the Dental Operating Room (OR)
briefings. Exposing Dental students, interns and residents to safety initiatives and incorporating
such initiatives into Dental educational curricula may encourage positive shift in the culture of
Operating Room and it may serve to get more future Dental Surgeons “to believe in the
importance of surgical safetylist and operative briefings rather than go through the motions.”
Conclusion –
The use of surgical safety checklist and Operating Room (OR) briefings as a routine procedure
helps to reduce preventable Dental surgical risks. Dental Hospitals should consider implementing

6. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
Safety Checklists and Operating Room (OR) briefings as a strategy to improve efficiency,
clinical and economic outcomes in Dental patients. Applied on a global basis, surgical safety
checklist and Operating Room (OR) briefings has the potential to prevent large numbers of
dental surgery complications, although further studies are needed to determine the precise
mechanism and durability of the effects of surgical safety list and Dental Operating Room
briefings in Dental Hospitals.
References -
i
Kohn LT, Corrigan JM, Donaldson MS.To Err is Human: Building a Safer Health System.
Washington, DC: National Academy Press; 2000.
ii
DeFontes J, Surbida S. Preoperative safety briefing project. Permanente J. 2003; 8(2):21-27.
iii
Awad SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the OR with
medical team training. Am J Surg. 2005; 190:770-774.
iv
Mason L, Garcia A. Hospital costs of surgical complications. Arch Surg.1984;119:1065–1066.
v
Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of
surgery: a modelling strategy based on available data. Lancet 2008;372: 139-44.
vi
Debas HT, Gosselin R, McCord C, Thind A. Surgery. In: Jamison DT, Breman JG, Measham
AR, et al., eds. Disease control priorities in developing countries. 2nd ed. Disease Control
Priorities Project. Washington, DC: International Bank for Reconstruction and
development/World Bank, 2006:1245-60.
vii
Makary MA, Sexton JB, Freischlag JA, et al. Operating room teamwork among physicians and
nurses: teamwork in the eye of the beholder. J Am Coll Surg 2006;202:746-52.
viii
Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA. Complications and costs after high-risk
surgery: where should we focus quality improvement initiatives? J Am Coll Surg 2003;196:
671–678.
ix
Thomas EJ, Zinner MJ, Brennan TA. The incidence and nature of surgical adverse events in
Colorado and Utah in 1992. Surgery 1999;126:66-75.
x
Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site
infections. Am J Surg 2005;190:9-15.

7. Dr.Shoeb and Dr.Irfana (2011): The predictive value of surgical safety checklist and operating Room
(OR)briefings in Dentistry.
DATE- 30-03-2011
xi
Chassin M, Galvin RW. The urgent need to improve health care quality. Institute of Medicine
national roundtable on health care quality. JAMA 1998;280:1000–1005.
xii
The Joint Commission. Universal protocol for preventing wrong site, wrong procedure, wrong
person surgery. http:// www.jointcommission.org/Patient Safety/UniversalProtocol.
xiii
Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and
mortality in a global population. N Engl J Med 2009;360:491-9.
xiv
. The New England Journal of Medicine, 360, p491, January 2009, ‘A Surgical Safety
Checklist to Reduce Morbidity and Mortality in a Global Population.
xv
Makary MA, Holzmueller CG, Thompson D, et al. Operating room briefings: working on the
same page. Jt Comm J Qual Patient Saf. 2006;32(6):351-355.