Kerala sets new surgery standards

Thiruvananthapuram: In a move aimed at strengthening patient safety and standardizing surgical care, the state govt has approved a comprehensive, unified surgical protocol for implementation across govt healthcare institutions. The decision follows a series of reported surgical errors in govt hospitals. Prepared by the directorate of medical education, the protocol aligns with global safety guidelines issued by the World Health Organization, while incorporating measures tailored to Kerala's healthcare system. The draft was recently submitted to the govt, which has now directed authorities to expedite its rollout. Officials said the protocol is designed to minimize surgical errors, improve coordination among medical teams and ensure consistent adherence to safety procedures from preoperative stages to post-surgical care. Under the new guidelines, ward doctors and nurses must complete a series of checks either on the night before surgery or early on the day of the procedure. These include verifying patient identity using multiple identifiers, cross-checking medical records and ensuring informed consent is obtained after proper counselling. Patients will be given colour-coded wristbands indicating whether the procedure is elective or an emergency, along with key medical details. Mandatory marking of the surgical site in the preoperative ward has been introduced to prevent wrong-site surgeries. A detailed preoperative checklist must be completed and verified before the patient is moved to the operating theatre. The protocol introduces a structured operating room system based on internationally recognised practices, including a three-stage checklist, sign-in, time-out and sign-out, for all types of anaesthesia. During the sign-in phase, conducted before anaesthesia, patient identity, surgical site and procedure details must be confirmed. Strict infection control practices and medication safety checks have also been mandated. The time-out phase, carried out before incision, requires all members of the surgical team to confirm patient details, procedure specifics, allergies and the availability of required equipment. In cases involving multiple procedures, additional time-outs must be conducted before each stage. The sign-out phase, conducted after surgery, focuses on accurate documentation, patient transfer decisions, and verification of all surgical instruments and materials. Strict counting and cross-checking of instruments and disposables are mandated to prevent retention errors.While establishing a uniform framework, the protocol allows departments to adapt checklists to their specific requirements. However, any modifications must be formally submitted for inclusion in institutional protocols. Health officials said the initiative is expected to further strengthen the state's public healthcare system by improving safety, accountability and quality in surgical procedures. Departments have been instructed to take urgent steps to ensure implementation across all medical facilities.
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