[A safer surgical pathway: monitoring in the operation room alone is insufficient]

Surgical adverse events remain a considerable problem: over 50% of in-hospital adverse events are related to a surgical procedure. The WHO, in its 'Safe surgery saves lives' campaign, propose what is essentially an expanded time-out procedure, including a debriefing. In recent years, this type of procedure has been widely advocated and implemented. While it is valuable, it has one major drawback: it is limited to the operating room. We recently observed 170 patients undergoing surgery. Over 50% of the incidents observed occurred outside the operating room, before and/or after surgery. Many near misses can be intercepted before entering the operating room. We therefore developed and validated a multidisciplinary checklist that covers the entire surgical patient pathway, instead of just the operative phase. The implementation of the so-called 'Surgical patient safety system' (SURPASS) checklist is currently underway. The effectiveness of the checklist in reducing adverse events and improving patient safety is being studied.