of Rhode Island

Hospital Association

On July 1, 2009, hospitals across Rhode Island took another important step in improving patient safety in our state. The date marked implementation of a uniform surgical protocol, making Rhode Island among the first states in the nation to have unanimous voluntary adoption of a surgical protocol. 

The protocol establishes uniformity across hospitals so health care practitioners working at multiple organizations will follow the same routine for all surgical procedures. The surgical protocol was developed after months of collaboration by leading experts in Rhode Island’s health care community and in consultation with the Joint Commission.

uniform surgical protocol

The Rhode Island surgical protocol includes the use of a checklist. A study published in the January 14, 2009 edition of the New England Journal of Medicine found the rate of death and complications were significantly reduced after the implementation of a World Health Organization (WHO) surgical checklist before, during and after surgery in certain populations 16 years of age and older. The Rhode Island protocol follows standards developed by WHO.

 Elements of the protocol include:

  •  Involving two licensed providers in the operative site marking, one being the surgeon
  •  Surgeon marks the operative site with his/her initials
  • Active participation by operating room team guided by the use of the checklist
  • A “time-out” initiated by the surgeon


The protocol has been endorsed by: the Joint Commission, Rhode Island Department of Health, Hospital Association of Rhode Island, Rhode Island Patient Safety Collaborative, Rhode Island Medical Society, Rhode Island Chapter of the American College of Surgeons and Rhode Island State Nurses Association.