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The SQUIRE 2.0 guidelines (Standards for QUality Improvement Reporting Excellence) are the reporting guideline for studies that describe system-level work to improve the quality, safety, and value of healthcare. They specify what a completed quality improvement (QI) report must document — the problem, the intervention, how it was studied, and what changed — so that readers, reviewers, and anyone trying to replicate or scale the improvement can evaluate the work. SQUIRE 2.0 was developed by Greg Ogrinc, Louise Davies, Daniel Goodman, Paul Batalden, Frank Davidoff, and Susan Stevens, and published simultaneously in 2015 across seven journals, including BMJ Quality & Safety, The Permanente Journal, and the Journal of the American College of Surgeons. It revises and replaces the original SQUIRE guidelines, first published in 2008.
Last verified 2026-08-24 against the EQUATOR Network’s SQUIRE reporting-guideline page and the SQUIRE Statement website.
The SQUIRE 2.0 Checklist
SQUIRE 2.0 comprises 18 items organized into six sections that follow the structure of a typical QI manuscript, from title through funding. Unlike SQUIRE 1.0, which listed numerous sub-items that authors found confusing, SQUIRE 2.0 condenses each section into a single, more flexible item. The table below summarizes what each section covers; complete the full checklist from the official source before submission, not from this summary.
| Section | What It Covers |
|---|---|
| Title and Abstract | Indicates the article concerns a QI initiative, and a structured or narrative summary of the problem, intervention, results, and conclusion. |
| Introduction | The problem description, available knowledge, a rationale grounded in the local context, and the specific aim(s) of the intervention. |
| Methods | The largest section — the local context in which the work took place, a full description of the intervention(s), how the intervention itself was studied (study design, comparator if any), the measures used (process, outcome, and balancing measures), the analytic methods, and ethical considerations, including local institutional review. |
| Results | The initial steps of the intervention and evolution over time, details of the process measures and outcome, contextual factors that interacted with the intervention, and unintended consequences. |
| Discussion | A summary of key findings, their interpretation in light of existing evidence and the intervention’s mechanism, missed opportunities, limitations specific to QI work (e.g. generalizability across contexts, secular trends, and the difficulty of blinding), and conclusions, including the work’s sustainability and potential for spread. |
| Other Information | Funding sources and the funder’s role, if any. |
The official, authoritative version of the checklist — including the exact wording of each item — is maintained on the EQUATOR Network’s SQUIRE reporting-guideline page and on the SQUIRE Statement website, which also hosts a detailed Explanation and Elaboration (E&E) document walking through each item with published examples.
Who Needs to Use SQUIRE 2.0
- Authors reporting a QI initiative. Any project that used a structured method (Plan-Do-Study-Act cycles, Lean, Six Sigma, or a similar improvement framework) to change a care process and measured the result falls within SQUIRE’s scope, whether the setting is a single unit, a whole hospital, or a multi-site collaborative.
- Journals in nursing, medicine, pharmacy, and surgery. Many clinical and health-services journals list SQUIRE as a submission requirement in their Instructions for Authors for QI manuscripts specifically, distinct from what they require for a clinical trial or an observational study.
- Educators and simulation researchers, via the SQUIRE extensions. SQUIRE-EDU (2019) adapts the guideline for reports of educational improvement work, and SQUIRE-SIM (2024) adapts it for simulation-based QI projects — both keep SQUIRE 2.0’s overall structure while adding guidance specific to their setting.
- Reviewers and editors who use the checklist to check a QI submission systematically, the same way CONSORT or PRISMA is used to check other study types.
How SQUIRE 2.0 Differs From a Clinical Trial or Observational Study Guideline
SQUIRE 2.0 exists because QI work does not fit cleanly into the reporting structure built for a randomized controlled trial or an observational study. A QI initiative is typically iterative (the intervention itself often changes across PDSA cycles), context-dependent (the same intervention can behave differently in different units), and rarely randomized or blinded. Reporting it against CONSORT, which assumes a fixed intervention tested against a control arm, would misrepresent how the work was actually done. SQUIRE 2.0 instead asks authors to describe the intervention’s evolution, the local context, and the mechanism by which the change is believed to produce the outcome — reporting demands closer to a non-randomized study than an RCT, but still distinct from either. For a systematic review that synthesizes QI evidence across multiple sites, PRISMA 2020 governs how that review itself is reported. CASRAI’s EQUATOR Network guide maps which of the more than 400 catalogued reporting guidelines applies to which study design; background on how a reporting guideline differs from methodological guidance is covered there.
Frequently Asked Questions
What does SQUIRE stand for?
Standards for QUality Improvement Reporting Excellence. SQUIRE 2.0 is the current, revised version, replacing the original SQUIRE guidelines published in 2008.
How many items are in the SQUIRE 2.0 checklist?
18 items across six sections: Title and Abstract, Introduction, Methods, Results, Discussion, and Other Information. The original 2008 SQUIRE guidelines had 19 items with numerous sub-items that authors found confusing; SQUIRE 2.0 condensed these into 18 more flexible items.
Is SQUIRE 2.0 required to publish a quality improvement study?
It depends on the journal, the same way it does for CONSORT or PRISMA. Many nursing, medical, and surgical journals list SQUIRE as a submission requirement for QI manuscripts in their Instructions for Authors. Always check the specific target journal rather than assuming.
What are SQUIRE-EDU and SQUIRE-SIM?
Extensions of SQUIRE 2.0 for specific settings. SQUIRE-EDU (2019) applies to reports of educational improvement work; SQUIRE-SIM (2024) applies to simulation-based quality improvement projects. Both preserve SQUIRE 2.0’s overall structure.
Where can I find the official SQUIRE 2.0 checklist to complete?
On the EQUATOR Network’s SQUIRE reporting-guideline page or the SQUIRE Statement website, both of which host the checklist and a detailed Explanation and Elaboration document with published examples for each item.
Related reading: Choosing a Critical Appraisal Tool for Your Study Design — how to pick the right instrument (CASP, AMSTAR 2, Newcastle-Ottawa, RoB 2) once you’re appraising, not authoring, a study.
See also: CHEERS 2022 Checklist — the equivalent reporting guideline for economic evaluations of health interventions.
