The "Sign in" phase is the first part of the WHO surgical safety checklist, conducted before the induction of anesthesia. During this step, at least a nurse and an anesthesia professional orally confirm critical patient safety points, including verifying the patient's identity, surgical site, and consent. They also ensure the team is aware of any known allergies, has evaluated the patient's airway and aspiration risk, and is prepared for potential significant blood loss.

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Developed by the World Health Organization (WHO), the surgical safety checklist is a tool used in medical facilities to improve patient safety. It is structured into three distinct phases that occur at critical points in the surgical process: "Sign in" before anesthesia, "Time out" before the first incision, and "Sign out" before the patient is transferred from the operating room.

WHO Surgical Safety Checklist

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Sign In Phase of the WHO Surgical Safety Checklist

The "Time out" phase is the second part of the WHO surgical safety checklist, performed just before the skin incision. The entire surgical team participates, orally confirming team member introductions, patient identity, and the surgical plan. During this pause, the surgeon, anesthesia staff, and nursing staff each review their specific critical concerns, such as unexpected steps, patient-specific issues, sterility, and equipment availability. They also confirm that prophylactic antibiotics have been administered if needed and that all essential imaging results are displayed.

Time Out Phase of the WHO Surgical Safety Checklist

The "Sign out" phase is the final part of the WHO surgical safety checklist, conducted before the patient is moved from the operating room. In this phase, a nurse leads a review of the recorded procedure name, confirms that counts of needles, sponges, and instruments are complete, verifies the correct labeling of any specimens, and addresses any equipment issues. To conclude, the surgeon, nurse, and anesthesia professional jointly review key concerns for the patient's recovery and ongoing care.

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