Preventing Never Events: Checklists, Timeouts, Debriefings, and Skin Marking

Many initiatives to improve surgical safety arose on the heels of the publication of the groundbreaking report “To Err is Human” by the Institute of Medicine. From this came the fundamental concept of never events, along with the tools to reduce harm to surgical patients, such as timeouts, debriefings, skin marking, and checklists. The last 20 years have demonstrated that safe surgical care requires the active participation and engagement of all healthcare providers who make up the perioperative team, with effective teamwork and communication underlying many interventions that have shown to be effective in reducing medical errors and improving postoperative morbidity and mortality. Reviewing these concepts is paramount to gaining a better understanding of how these interventions were created. This chapter reviews lessons learned and provides recommendations on how to effectively implement these interventions.