This template has been customized for hospitals in South Carolina. This checklist has been modified to include SCIP items as well as additional checklist items to enhance communication and teamwork. It is designed to be used in the majority of surgical cases and takes into account that the surgeon might not be in the OR at the time of induction. Click here to download.
This template should be used if the surgeon is present at the time of induction. It contains the same checklist elements as the above template, but the timing in which various elements take place has been modified accordingly. Click here to download.
This template was created for hospitals where all team members know everyone by name and feel uncomfortable performing introductions before each case. If this is the case in your hospital, the surgical team members should introduce themselves by name and role prior to the first case and have the surgeon address each team member by name and ask if they are ready to proceed before skin incision. Click here to download.
This template, based on a version created in an ambulatory surgery center in South Carolina, divides the checklist in to two separate parts. This style lay-out may help hospitals who are dealing with issues of checklist flow and staff buy-in. To download this checklist template, please click here.
This template was created for use inside Ambulatory Surgery Centers (ASCs) in South Carolina. It was created as a two page lay-out to meet the workflow needs of ASCs. To download this checklist template, please click here.