Table 1 Most frequently reported safety hazards and recommendations to minimize their occurrence

Unreliable documentation of pre-operative health status

• National uniform health declaration

• Standardized surgery notification form (Mandatory registration of the most important data, consistent registration of contagious conditions, and preset limitations of care)

• Standardized routines for pre-operative assessment

• Routine use of ASA classification

• Selective pre-operative anaesthesiologist assessment based on ASA classification (Patients with ASA I-II are assessed on request; those with ASA IV are assessed invariably.)

Divergent systems of documentation between different units

• Consistent admission notes (structured with standard headings, preferably partly delegated to a specialist nurse)

• Systems for documenting important medical information accessible to everyone

• Systems for patient records with a structure suitable for surgery as well as anaesthesia Harmonization of management programmes of clinics involved in the same course of care

• Coordinated and uniform systems for drug prescriptions for anaesthesia and surgery

Insufficient planning of high-risk procedures

• Multidisciplinary forum for evaluation of high-risk patients

• Weekly scheduling of surgical programmes operations in the entire unit

• Daily scheduling of programmes in each theatre

Inconsistent use of checklists

• Routine use of the WHO checklist

Lack of standardized communication

• Open dialogue during surgery

• Team training with anaesthesia and surgery crew

• Reporting based on SBAR

No routines for feedback on adverse events

• Mortality and morbidity conferences common to surgery and anaesthesia personnel