Mass Implementation of Surgery Checklists on Heels

We reported last month on the HealthLineRX blog statistics for a six-year Colorado study that revealed an alarming rate of surgeries gone wrong. There were 107 cases of procedures done on the wrong part of a patient’s body, and 25 done on the wrong patient, which resulted in one death. And this was just for one state!

A new study released this week provides another compelling piece of research for the implementation of surgical checklists in all hospitals. Despite the body of work that now exists in favor of these checklists, only about one in four U.S. hospitals have implemented surgical checklists, according to the Boston Globe.

The latest study was carried out in the Netherlands, where six hospitals began to use a comprehensive array of 11 surgery checklists that were enforced from the moment the patient arrived at the hospital until they were discharged.

The checklists included about 100 line items in total, from pre-op to post-op recovery. The lists included direct responsibilities for hospital staff members, as well as precautionary measures such as ensuring that blood was available if necessary.

The Netherlands study included 3,800 patients who underwent surgery before the checklists were implemented, and 3,800 patients who had surgery after the checklists were in place. Researchers found that the checklists reduced complications by one-third (from 27 to 17 per 100 patients) while cutting in-hospital deaths in half (from 1.5 to 0.7 percent).

Although the study entailed a relatively low amount of patients, the medical community said the research was incredibly valuable because it reinforced an existing database of studies that revealed similar results. One of these studies was detailed in this October’s issue of the Journal of the American Medical Association. Surgical-related deaths were reduced by 18 percent at 108 Veterans Administration hospitals where pre- and post-surgical debriefings, as well as checklists, were put into practice.

Inspired by the aviation industry, checklists are also heavily supported by Dr. Atul Gawande, a Brigham and Women’s Hospital surgeon. He has insisted that all surgical teams should ask a simple set of questions before they begin any procedure. When this concept was tested at eight hospitals from Seattle to Tanzania, it cut deaths and other serious problems almost in half.

A study released in May found that a surgery checklist developed by the World Health Organization decreased major complications by 36 percent.

Dr. John Birkmeyer, a surgeon and director of the Center for Healthcare Outcomes and Policy at the University of Michigan, wrote an editorial to accompany the Dutch study, published in the Nov. 11 issue of the New England Journal of Medicine.

He said surgical checklists should now be considered more than just best practice. They should be implemented globally, he said, because they can prevent tens of thousands of surgical deaths, and hundreds of thousands of serious complications every year – and that’s just in the United States.

Birkmeyer said that the specific line items in the checklists are actually less important than the overall factors of teamwork, communication and other aspects of safety culture that the checklists inherently create.