About the Network
CROSS-CHECK
A multi-centre CROSS-sectional study and audit of surgical safety CHECKlist Modification
CROSS-CHECK STUDY
Study Aim
To investigate the extent, nature and process of surgical safety checklist modification in the United Kingdom.
Status: Recruiting Centres
Registration: March 2025 – 20th July 2025
Data Submission Deadline: 24th August 2025
Collaborating Centres
Study Information
Background
The World Health Organisation (WHO) surgical safety checklist is a 19-point checklist that is used worldwide in an effort to reduce surgical errors and adverse events. In the UK, completion of the checklist is mandated for every surgical and invasive procedure1
The checklist was designed as a template which could be modified for every surgical environment. Adaptation of the checklist to suit local requirements is an important step in optimising checklist buy-in and performance. Further adaptation in response to local or national patient safety incidents is also encouraged1. However, over-modification could have a negative impact on checklist utility, communication and teamwork, and should be done in accordance with the WHO guidelines2.
Little is known about the extent of checklist modification in the United Kingdom and the extent to which modifications abide by WHO and NICE guidelines for checklist modification.
References:
1) NICE guidelines [NG180 1.4.8]
2) The WHO Surgical Safety Checklist: Adaptation Guide
About The Study
The study will be led by the Human Factors in Surgery Network (HFSN) and will utilise a trainee collaborative model for data collection. All UK NHS Trusts/Boards in which surgical and/or invasive procedures are undertaken will be eligible for the study.
Study Protocol
The study will consist of 3 elements:
- Survey relating to the checklist governance and the process of checklist modification in UK NHS trusts/boards
- Audit of WHO surgical checklist use and modification
- Cross-sectional study comparing checklist content and modifications with the WHO Surgical Safety Checklist 2009
Study Methods
Local collaborators will be recruited from UK trusts and will be required to:
- Obtain and submit copies of all WHO surgical safety checklist(s) used in their local trust/board.
- Obtain a completed Checklist Governance Survey from a member of the trust/board clinical governance committee.
Further information and guidance on how to obtain the above data will be provided after sign-up. The data from the checklist and survey will be analysed by the steering committee. Local collaborators will also be encouraged to audit their local checklist(s) and guidance will be provided by the steering committee.
Getting Involved
Registration will open in March 2025 and close in 20th July 2025.
Surveys and checklists must be submitted by 24th August 2025.
Inclusion Criteria
We are welcoming ONE local collaborator per NHS Trust/Board (please see the above map for details of NHS Trusts/Boards which already have assigned local collaborators).
Resident doctors, consultants, associate specialist doctors, advanced or surgical care practitioners, research nurses and medical students working in UK NHS Trusts/Boards are eligible to apply to become a CROSS-CHECK local collaborator.
The trust/board must perform surgical and/or invasive procedures.
Collaborators must seek approval of a local consultant supervisor prior to application.
Collaborators who submit their trust/board’s WHO surgical safety checklists AND a completed Checklist Governance Survey will receive collaborator status and be named as a collaborative author on all publication and presentations.
Ethics & Audit Registration
As per the University of Oxford research classification committee, ethical approval is not required as this is a clinical audit and no patient information will be requested.
However, local collaborators are required to register the project as an audit with their local audit/quality improvement team (NB: not required at the time of application, but will be required prior to submitting data for analysis).
Guidelines
Collaborator Guidelines:
For further information please see the FAQ section below, or email us at humanfactorsnetwork@gmail.com
FAQ
Who can get involved?
Inclusion Criteria
We are welcoming ONE local collaborator per NHS Trust/Board (please see the above map for details of NHS Trusts/Boards which already have assigned local collaborators).
Trainee doctors, associate specialist doctors, advanced or surgical care practitioners, research nurses and medical students working in an UK NHS Trust/Board are eligible to apply to become a CROSS-CHECK local collaborator.
Collaborators must seek approval of a local consultant supervisor prior to application.
The trust/board must perform surgical and/or invasive procedures. The study is open to participants from all NHS Trusts/Boards in England, Scotland and Wales, and Health and Social Care Trusts in Northern Ireland.
Private hospitals, and those outside the UK are not eligible.
How many collaborators are allowed per NHS Trust/Board?
We are welcoming ONE local collaborator per NHS Trust/Board (please see the above map for details of trusts which already have assigned local collaborators), except in specific circumstances (see below).
Collaborators must seek approval of a local consultant supervisor prior to application.
Someone has already signed up for my trust, can I still be involved?
We are accepting one local collaborator per NHS Trust/Board. In cases where checklists cannot be obtained from the trust clinical governance committee, and need to be manually collected for each hospital, more than one local collaborator per trust will be accepted. Where local collaborators have failed to collect the required data within 6 weeks of sign-up approval, the local collaborator will be contacted by the steering committee and the role may be offered to others.
What is a Consultant Supervisor?
Any consultant working in the same trust can be a consultant supervisor for a local collaborator.
However, where possible, we recommend approaching a consultant with an interest in clinical governance as they may be based placed to help support the study and assist with contacting the trust/board clinical governance committee in order to obtain a completed Clinical Governance Survey.
For example:
- Departmental clinical governance lead
- Head of clinical governance for surgery or anaesthesia
What do I get out of it?
Collaborators who submit their trust’s WHO surgical safety checklists AND a completed Checklist Governance Survey will receive collaborator status and be named as a collaborative author on all publications.
Collaborators who do not meet this criteria will be acknowledged in the manuscript but will not receive collaborator status.
Consultant supervisors are also eligible for collaborative author status.
We encourage presentation of audit findings at local audit and research meetings and further guidance will provided by the steering committee.
When does the project open?
Registration will open in March 2025 and close in 1st June 2025.
Surveys and checklists must be submitted by 31st July 2025.
This sounds great! How do I sign up?
Please read all the information in the collaborator guideline document before registration, and then fill in some basic details using the link and a member of our team will be in touch with further information.
About
Dedicated to advancing the understanding and application of human factors in surgery, anaesthesia and peri-operative medicine.
