The SURgical PAtient Safety System (SURPASS): Development and Implementation of a Tool for a Safer Surgical Pathway

operating team confirm the patient's identity, the procedure and the operative site3,4. While this procedure is unquestionably valuable, it is limited in scope, both spacially and temporally. Not checking the essentials until inside the operating room may lead to compromised safety and/ or postponement of surgery, resulting in considerable psychological burden for the patient. In addition, after surgery, the patient is not safely home just yet: many adverse events originate in the postoperative phase. Purpose of the Study To develop and validate a surgical safety checklist that monitors critical safety risks and information transfers during the entire surgical pathway and to evaluate its use in clinical practice. Methods The design of the checklist was informed from a review of the human factors literature. Publications on causes, nature and locations of surgical errors, complications and adverse events were consulted to identify the critical safety risks in each stage of the surgical pathway. The data from both literature studies were combined to form the prototype checklist. This prototype checklist was then validated by observing 171 surgical procedures in a structured manner. All observed process deviations, i.e. deviations from optimal care, were compared to the checklist and scored as: 'corresponding to item on checklist', 'not corresponding to item on checklist', and 'not suitable for checklist'. Subsequently, minor adaptations were made to the list and the usability of the optimized checklist was evaluated in daily clinical practice. Results Of a total of 593 observed process deviations, 343 (58%) took place outside of the operating room, before or after surgery. Of these pre- and postoperative deviations, 95% corresponded to an item on the checklist. During surgery, 44% of observed deviations corresponded to an item on the list. Most of the deviations that did not correspond to an item on the list were