Revised statement on safe surgery checklists,
and ensuring correct patient, correct site,
and correct procedure surgery
The ACS recognizes patient safety as an item of the highest priority and strongly urges individual hospitals and health care organizations to develop
guidelines and checklists to ensure correct patient,
correct site, and correct procedure surgery.
Therefore, the ACS recommends the following
guidelines to eliminate wrong site surgery:
•Verify that the correct patient is taken to the operating room (OR). This verification can be made with the
patient or the patient’s designated representative if the
patient is underage or unable to answer for him/herself.
•Verify that the correct procedure is on the OR schedule.
•Verify with the patient or the patient’s designated representative the procedure that is expected to be performed,
as well as the anatomic location of the procedure.
•Confirm the submission of a consent form with the
patient or the patient’s designated representative.
•In the case of a bilateral organ, limb, or anatomic site
(for example, hernia location of melanoma), the surgeon
and patient should be in agreement and the operating
surgeon should mark the site before giving the patient
narcotics, sedatives, or anesthesia. For spine cases, level
should be verified.
•If the patient is scheduled for multiple procedures that
will be performed by multiple surgeons, all the items
on the surgical checklist must be verified for each
•Ensure that all relevant records, imaging studies, equipment, and implants are available as needed.
• Conduct a briefing prior to administering anesthesia and
call for a final time out before skin incision. These two
steps should include verification with members of the
surgical team to confirm the correct patient, site, and
procedure. If any verification process fails to confirm the
correct site, all activities should be halted until verification is confirmed to be accurate by the surgeon and team.
•Conduct a debriefing prior to the patient leaving the
OR; the debriefing should include verbal discussion of
sponge and needle counts.
• In the event of an emergency, these steps may be modified according to local hospital guidelines. ♦
The ACS offers this statement for consideration by surgeons, their hospitals, and health care organizations. This
statement is provided as general guidance. It does not constitute a standard of care and is not intended to replace the
professional judgment of the surgeon or health care administrator. This statement may be reviewed and modified as necessary to conform with the laws of the applicable
jurisdiction, the circumstances of the individual hospital
and health care organization, and requirements of other
allied and health care organizations.
The following statement was revised by the American College of Surgeons (ACS) Committee on Perioperative
Care and the revision was reviewed and approved by the ACS Board of Regents at its June 2016 meeting.
The Joint Commission. Universal protocol for preventing
wrong site, wrong procedure and wrong person surgery.
Available at: www.jointcommission.org/standards_
information/ up.aspx Accessed August 8, 2016.
World Health Organization. WHO Safe Surgery Checklist.
Available at: www.who.int/patientsafety/safesurgery/
ss_checklist/en/. Accessed August 8, 2016.