Simple Surgical Checklist Reduces Deaths, Complications

Inspired by the pre-flight checklists used by airline cockpit teams to maximize flight safety, the World Health Organization (WHO) has concluded a study on operating-room checklists for surgical teams, finding that deaths and serious complications can be reduced by more than one-third.     “We know that many surgical complications are preventable,” said Bryce Taylor, surgeon in chief for the University of Toronto’s Health Network, who co-authored the study for the Toronto General Hospital (TGH), one of eight hospitals that participated in the pilot study. “With approximately 234 million surgeries performed each year worldwide, we owe it to our patients to look at every opportunity to prevent complications during and after surgery.”

The WHO checklist was developed by a global group composed of prominent surgeons, nurses, anesthesiologists and patient safety experts.
   
Studies in industrialized countries have revealed that major complications occur in 3 percent to 16 percent of in-hospital surgeries, and that death rates for such surgeries are 0.4 percent to 0.8 percent.
   
In the study, which was published in the New England Journal of Medicine and spearheaded by the WHO and Atul Gawande of the Harvard School of Public Health, each hospital collected information on a number of patients before the checklist was implemented, to establish a baseline for comparison, and then on a roughly equal number afterward. At TGH, a total of 3,733 patients were followed before starting the checklist, and 3,955 patients were observed after it was introduced.
   
The study found that:
   
-- Patients who experienced major complications fell from a rate of 11.0 percent before the checklist to 7.0 percent after – a drop of more than a third.
   
-- Patients who died postoperatively fell from 1.5 percent to 0.8 percent, a decrease of more than 40 percent.
   
-- Similar results were observed in hospitals in both industrialized and developing areas of the world, with complication rates falling from 10.3 percent down to 7.1 percent and 11.7 percent to 6.8 percent respectively. Besides Toronto, the participating hospitals were in New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London; and Seattle.

The checklist mandates that a member of the surgical team verbally ticks off a variety of items at three crucial points during surgery – before anesthesia, immediately before incision, and before the patient exits the operating room. The items include such things as ensuring that the environment is completely sterile, that the anesthesia is fully safe, that the surgery site is marked, and that the sponges and instruments used are counted to ensure that nothing is left inside the patient.


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