At which stage of the World Health Organization (WHO) surgical safety checklist is patient identity or identification revision done?

Patient Identity Verification in the WHO Surgical Safety Checklist

Patient identity verification is performed during the "Time out" stage (C) of the WHO Surgical Safety Checklist.

Understanding the WHO Surgical Safety Checklist Stages

The World Health Organization (WHO) Surgical Safety Checklist consists of three critical stages:

1. Sign in: Occurs before induction of anesthesia
2. Time out: Occurs before surgical incision
3. Sign out: Occurs before the patient leaves the operating room

Time Out: The Critical Stage for Patient Identity Verification

During the "Time out" stage, the entire surgical team pauses immediately before the surgical incision to confirm several critical elements 1:

• Patient's full name
• Date of birth
• Medical record number
• Procedure to be performed
• Surgical site and side (if applicable)

This verification process requires:

• Active participation from all team members
• Verbal confirmation of the patient's identity
• Cross-checking against documentation (wristband, consent form, medical records)
• The surgeon typically leads this process

Evidence Supporting the Time Out Process

The implementation of the time out procedure has been shown to significantly reduce the risk of wrong-site surgeries and improve team communication 1. Studies have demonstrated that proper implementation of surgical safety checklists can reduce complications by up to 57% 2.

In a study of 3000 consecutive pediatric surgical patients, the time out process identified critical issues including:

• 1.8% of cases where children had identical names and procedures on the same operation list
• 0.1% of cases where patient identification tags were missing
• 3.6% of cases where the side of procedure was missing from documentation 3

Common Pitfalls in Patient Identification

Several barriers can compromise effective patient identification during the time out process:

• Rushing through the verification process
• Passive participation from team members
• Distractions in the operating room
• Hierarchical barriers preventing open communication
• Assuming someone else has verified the patient's identity 1

Implementation Across Surgical Settings

The time out process should be implemented in all surgical settings, including:

• Main operating rooms
• Ambulatory surgery centers
• Interventional radiology suites
• Endoscopy units
• Bedside procedures requiring sedation 1

For high-risk situations such as patients with similar names, multiple procedures, bilateral procedures, emergency surgeries, and procedures involving multiple surgical teams, the time out process is particularly critical for preventing errors.