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Surgeons have a duty to contribute to and comply with systems and processes that aim to reduce risk of harm to patients by measuring and monitoring performance and quality of care. The use of outcome measures should be a regular part of day-to-day clinical practice. In meeting the standards of Good Medical Practice, you should:

• Comply with standardisation and reliability processes that promote patient safety, such as national and local standard operating procedures.
• Be fully versed in the principles and practice of the WHO Surgical Safety Checklist (World Health Organization, 2008) and its adaptation through the Five Steps to Safer Surgery (National Patient Safety Agency, 2010) and apply those as an essential part of your operating work wherever this takes place, including private practice. The checklist can be adapted to suit local clinical environments and different specialties but the following broad tasks should be included:
  
  
  • Team briefing: All members of the surgical team should attend the team briefing at the beginning of the list to ensure a shared understanding of the requirements of that list, identify skill levels, staffing and equipment requirements, and prepare for anticipated problems.
  • Sign in before the administration of anaesthesia allows the team to ensure that the patient’s known allergies have been checked and that surgical site on the patient’s body has been properly marked will be visible in the operative field after draping.
  • Time out before the first incision allows members of the wider theatre team to introduce themselves if they have not previously done so and encourages them to speak out if they identify any concerns at this stage.
  • Sign out before the patient leaves the theatre guarantees that instruments, sponges and needles have been counted to ensure that none have been left behind in the patient’s body.
  • Debriefing: wherever possible, all members of the surgical team should participate in a discussion at the end of the operating list or at the end of the session, to consider good points of the operating process and teamwork, review any issues that occurred, answer concerns that the team may have, and identify areas for improvement.
• Recognise the risk of surgical site infection and the potential for cross-infection and follow local infection control procedures.

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