Experience Summary

In this 360-degree video, observe the World Health Organization (WHO) Surgical Safety Checklist being performed prior to the paediatric patient’s tonsillectomy.

Clinical Context

A tonsillectomy is the surgical removal of the palatine tonsils; often this is done together with adenoidectomy (adenotonsillectomy) in paediatric patients. The procedure is among the most common childhood surgeries and is considered when the tonsils cause significant problems that are not adequately controlled by medical therapy.

Indications:

• Recurrent tonsillitis / sore throats: frequent episodes of bacterial tonsillitis (e.g., meeting criteria such as the “Paradise” criteria: for example seven or more episodes in one year, or five or more per year over two years, or three or more per year over three years).
• Sleep-disordered breathing / obstructive sleep apnoea (OSA): when tonsil and/or adenoid hypertrophy obstruct the airway, causing snoring, disturbed sleep, behavioural or growth issues.
• Severe complications: peritonsillar abscess not responsive to drainage/medical management; rare but serious issues like febrile seizures triggered by tonsillitis or tonsillar disease suggestive of malignancy (e.g. unilateral enlargement).

These interventions are weighed against the risks, as tonsillectomy has potential complications: bleeding (intra- and post-operatively), anaesthetic risk, pain, swallowing difficulties, dehydration, etc. Moreover, many guidelines emphasise that not all children with sore throats or tonsillitis are good candidates; quality of life, severity, frequency, response to medical therapy, and comorbidities must be considered.

Clinical Context

The WHO Surgical Safety Checklist plays a vital role in improving patient safety across all surgical specialties, and its significance is particularly evident in paediatric tonsillectomy—a high-volume procedure performed on a uniquely vulnerable population. Children undergoing tonsillectomy face specific risks, including anaesthetic complications, airway obstruction, haemorrhage, and postoperative respiratory compromise. These factors make structured communication, anticipation of risks, and coordinated teamwork essential. The WHO checklist provides a standardised framework to support these objectives.

In the paediatric context, preoperative assessment is often more complex. Children may be unable to communicate symptoms clearly, have unrecognised comorbidities such as obstructive sleep apnoea, or experience heightened anxiety that complicates induction. The checklist’s “Sign In” section reinforces the verification of identity, procedure, allergies, fasting status, and airway risk—elements that are especially critical when the airway is shared between the surgical and anaesthetic teams. This stage ensures that potential difficulties, such as anticipated challenging intubation or bleeding tendencies, are identified early and communicated clearly.

Tonsillectomy carries a recognised risk of intraoperative bleeding and postoperative airway compromise, making robust team coordination essential. During the “Time Out” pause, the checklist promotes explicit confirmation of the planned procedure, availability of appropriate equipment, and readiness to manage complications. It also fosters situational awareness by encouraging team members to voice concerns, clarify roles, and ensure that critical instruments—such as suction devices, diathermy equipment, or emergency airway tools—are functional and immediately accessible.

Postoperatively, children are at increased risk of respiratory events, pain-related distress, and delayed haemorrhage. The “Sign Out” stage of the checklist prompts a final review of instrument counts, specimen handling (when applicable), and postoperative plans. This includes confirming the need for enhanced monitoring, analgesia strategies, or admission for high-risk patients. Such structured communication reduces the likelihood of omissions that could compromise recovery.

Beyond its direct clinical applications, the WHO checklist strengthens the culture of safety within surgical teams. In paediatric tonsillectomy—where multidisciplinary collaboration between surgeons, anaesthetists, nurses, and recovery staff is essential—the checklist acts as a shared cognitive aid that improves consistency and reduces variability in care. Its use has been associated with reduced perioperative complications, lower mortality, and improved team performance.

Learning Outcomes

1. Observe the WHO checklist being used in practice.
2. Increase understanding of the components of the WHO safety checklist.
3. Observe the roles of the MDT in the WHO safety checklist.
4. Increase understanding of the importance of using WHO safety checklists in clinical practice.

External Resources

• British Association for Paediatric Otorhinolaryngology - Day Case Paediatric Adenotonsillectomy Consensus Guideline
• World Health Organization – Surgical Safety Checklist (First edition, 2008)
• Royal College of Surgeons – Five steps to safer surgery (adapted version of the WHO checklist used in UK practice)