Atrius India Core FHIR Implementation Guide
0.1.0 - ci-build

Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: Surgical Safety Checklist (Experimental)

Official URL: https://atrius.in/fhir/r4/atrius-in/Questionnaire/surgical-safety-checklist Version: 0.1.0
Active as of 2026-07-11 Computable Name: SurgicalSafetyChecklist
Other Identifiers: OID:1.3.6.1.4.1.66219.1.35.3

Adapted from the WHO Surgical Safety Checklist. Complete each phase with the whole team present; a completed response is required once per surgical encounter.

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. SurgicalSafetyChecklist Adapted from the WHO Surgical Safety Checklist. Complete each phase with the whole team present; a completed response is required once per surgical encounter. Questionnaire https://atrius.in/fhir/r4/atrius-in/Questionnaire/surgical-safety-checklist#0.1.0
... sign-in Sign in — before induction of anaesthesia 0..1 group Value Set:
.... sign-in-identity Patient has confirmed identity, site, procedure, and consent 1..1 boolean Value Set:
.... sign-in-site-marked Surgical site is marked (or marking not applicable) 0..1 boolean Value Set:
.... sign-in-anaesthesia-check Anaesthesia machine and medication check complete 1..1 boolean Value Set:
.... sign-in-pulse-oximeter Pulse oximeter on the patient and functioning 1..1 boolean Value Set:
.... sign-in-allergy Does the patient have a known allergy? 1..1 choice Value Set:
Options: 2 options
.... sign-in-airway Difficult airway or aspiration risk? 1..1 choice Value Set:
Options: 2 options
.... sign-in-blood-loss Risk of more than 500 mL blood loss (7 mL/kg in children)? 1..1 choice Value Set:
Options: 2 options
... time-out Time out — before skin incision 0..1 group Value Set:
.... time-out-introductions All team members introduced by name and role 1..1 boolean Value Set:
.... time-out-confirmation Patient, site, and procedure confirmed aloud 1..1 boolean Value Set:
.... time-out-antibiotics Antibiotic prophylaxis given within the last 60 minutes? 1..1 choice Value Set:
Options: 2 options
.... time-out-critical-events Anticipated critical events reviewed (surgeon, anaesthetist, nursing) 1..1 boolean Value Set:
.... time-out-imaging Essential imaging displayed? 1..1 choice Value Set:
Options: 2 options
... sign-out Sign out — before the patient leaves the operating room 0..1 group Value Set:
.... sign-out-procedure-recorded Name of the procedure recorded 1..1 boolean Value Set:
.... sign-out-counts Instrument, sponge, and needle counts complete 1..1 boolean Value Set:
.... sign-out-specimen Specimen labelled (including patient name)? 1..1 choice Value Set:
Options: 2 options
.... sign-out-equipment Equipment problems identified and addressed 0..1 boolean Value Set:
.... sign-out-recovery Key concerns for recovery and management reviewed 1..1 boolean Value Set:
.... sign-out-notes Additional notes (optional) 0..1 text Value Set:

doco Documentation for this format

Options Sets

Answer options for sign-in-allergy

  • No
  • Yes

Answer options for sign-in-airway

  • No
  • Yes, and equipment/assistance available

Answer options for sign-in-blood-loss

  • No
  • Yes, and adequate IV access and fluids planned

Answer options for time-out-antibiotics

  • Yes
  • Not applicable

Answer options for time-out-imaging

  • Yes
  • Not applicable

Answer options for sign-out-specimen

  • Yes
  • Not applicable

Sign in — before induction of anaesthesia

  • linkId: sign-in
  • Answers:

Patient has confirmed identity, site, procedure, and consent*

  • linkId: sign-in-identity
  • Answers:

Surgical site is marked (or marking not applicable)

  • linkId: sign-in-site-marked
  • Answers:

Anaesthesia machine and medication check complete*

  • linkId: sign-in-anaesthesia-check
  • Answers:

Pulse oximeter on the patient and functioning*

  • linkId: sign-in-pulse-oximeter
  • Answers:

Does the patient have a known allergy?*

Difficult airway or aspiration risk?*

Risk of more than 500 mL blood loss (7 mL/kg in children)?*

Time out — before skin incision

  • linkId: time-out
  • Answers:

All team members introduced by name and role*

  • linkId: time-out-introductions
  • Answers:

Patient, site, and procedure confirmed aloud*

  • linkId: time-out-confirmation
  • Answers:

Antibiotic prophylaxis given within the last 60 minutes?*

Anticipated critical events reviewed (surgeon, anaesthetist, nursing)*

  • linkId: time-out-critical-events
  • Answers:

Essential imaging displayed?*

Sign out — before the patient leaves the operating room

  • linkId: sign-out
  • Answers:

Name of the procedure recorded*

  • linkId: sign-out-procedure-recorded
  • Answers:

Instrument, sponge, and needle counts complete*

  • linkId: sign-out-counts
  • Answers:

Specimen labelled (including patient name)?*

Equipment problems identified and addressed

  • linkId: sign-out-equipment
  • Answers:

Key concerns for recovery and management reviewed*

  • linkId: sign-out-recovery
  • Answers:

Additional notes (optional)

  • linkId: sign-out-notes
  • Answers:

LinkIDDescription & Constraintsdoco
.. sign-in Value Set:
... sign-in-identity Value Set:
... sign-in-site-marked Value Set:
... sign-in-anaesthesia-check Value Set:
... sign-in-allergy Value Set:
Options: 2 options
... sign-in-airway Value Set:
Options: 2 options
... sign-in-blood-loss Value Set:
Options: 2 options
.. time-out Value Set:
... time-out-introductions Value Set:
... time-out-confirmation Value Set:
... time-out-antibiotics Value Set:
Options: 2 options
... time-out-critical-events Value Set:
... time-out-imaging Value Set:
Options: 2 options
.. sign-out Value Set:
... sign-out-procedure-recorded Value Set:
... sign-out-counts Value Set:
... sign-out-specimen Value Set:
Options: 2 options
... sign-out-equipment Value Set:
... sign-out-recovery Value Set:
... sign-out-notes Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.