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Study: Simple Surgical Checklist Saves Lives

BY Admin  January 16, 2009 at 1:10 PM EDT

Surgeons; file photo

The 19-point list, which takes less than two minutes to complete, requires doctors and other surgical staff to do basic checks of anesthesia, blood supply, the site to be operated on — even a roll call of the surgical team.

“An operation involves hundreds of steps with lots of team members,” study author Atul Gawande, a surgeon and professor at the Harvard School of Public Health, told USA Today. “We’re good at making sure we do most of these things most of the time, but we’re not good at doing all of them all of the time.”

In the study, Gawande and his colleagues introduced the checklist — modeled after one used by airline pilots — to hospitals in Canada, the United States, England, New Zealand, Jordan, India, Tanzania and the Philippines. They then compared the surgical death rate at those hospitals to the death rate before the checklist was introduced. On average, the death rate fell from 1.5 percent to .8 percent. The rate of surgical complications fell from 11 percent to 7 percent.

Gawande told the New York Times that it was hard to tell which items on the checklist made the most difference, but that it was likely a combination of many. The checklist items range from the seemingly obvious — verifying that all the needed equipment is sterilized and available — to the less obvious.

The “roll call” item was added because research has shown that operating room communication problems — such as junior members of a surgical team being afraid to speak up when they see something going wrong — can have serious consequences.

“Giving them a chance to say their names allows them to speak up later,” Gawande told the New York Times.

Gawande, an author as well as a surgeon, has written about checklists before. In a 2007 New Yorker article, he wrote about a physician who used checklists to reduce infections in an Intensive Care Unit.

Safety organizations worldwide have already expressed interest in working to bring the checklist into hospitals, and four countries — the United Kingdom, Ireland, Jordan and the Philippines — already plan to use it in all operations, according to USA Today.