DOI: 10.1093/bjs/znad258.614 ISSN:

1132 UseBeforeSurgery-Practical Tips (UBS-PT) Initiative: Enhance Patient Safety with Tips Inspired by Military and Civil Aviation

L L Di Stasi, J M Sánchez Carrión, B Mawhin, C Diaz-Piedra
  • Surgery



The healthcare system, to improve its culture of safety, often have looked at high-reliability organisations including the aviation industry. However, while some flight-safety tools have been slowly introduced into perioperative procedures (e.g., Surgical-Safety Checklist), many guidelines related to Non-Technical-Skills for Surgeons (NOTSS) have obtained low adherence. The apparent time-consuming nature of their implementation have represented a major barrier to the flourish of the NOTSS system. Thus, complementary initiatives, such as the UBS-PT presented here, are needed. The UBS-PT is a list of practical tips aimed at improving patient safety and surgical performance.


By applying a reiterative evidence-based developing process involving healthcare professionals, military pilots, human factors, and legal experts, we identified several practical tips to enhance surgical performance. The developing process and operationalization were complemented by a deep literature review to weight tips’ efficiency, cost-effectiveness, usability, and ease of implementation.


Within NOTSS system framework, we defined ten practical tips promoting the use of (1) group chair-flying, (2) colour-coded stickers, (3) standardised layouts, (4) closed-loop communication, (5) labelled and colour-coded surgical caps, (6) cross-checking and (7) two-challenge rule procedures, (8) the sterile cockpit rule, (9) self-checklist, and (l0) tactical napping.


In an attempt to meet the increasing standards of quality and safety in patient care, the UBS-PT initiative might encourage surgical teams and patient safety boards to find more suitable initiatives for each specific context. The UBS-PT initiative might represent the first step towards a tailored approach, offering concrete measures for the development of safety practices at individual and team levels.

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