Lifebox
The WHO checklist was designed for a global population and is as equally applicable in middle- and low-income countries as it is in high-income countries, with the gains likely to be significantly higher. Patient outcomes in the low- and middle-income settings, particularly from anaesthesia, are orders of magnitude worse than in high-income settings. The anaesthesia team that worked with the SSSL project considered the interventions required to improve anaesthesia safety in all settings, and on the basis of evidence concluded that safe anaesthesia was not feasible without basic monitoring in the form of a pulse oximeter. There are an estimated 77 700 operating theatres worldwide that do not have access to pulse oximeters, despite this being a minimum requirement in 58 countries with national anaesthesia monitoring standards and a requirement of international standards for a safe practice of anaesthesia. A quality improvement study indicated that it was feasible to introduce pulse oximeters into low-income settings with appropriate educational support and that this was associated with a change in practice.
The introduction of the WHO checklist with pulse oximetry is the focus of the WHO Global Pulse Oximetry Project and a new charity called Lifebox has been formed by the Association of Anaesthetists of Great Britain and Ireland, the World Federation of Societies of Anaesthesiologists, and the Harvard School of Public Health specifically for this purpose (www.lifebox.org). Pilot studies are underway to assess the impact of this initiative, and as of April 2012, over 1700 low-cost pulse oximeters have been supplied through this project.