Massachusetts Personal Injury Library
Surgical checklist improves chances for survival, Andover, MA
A recent New York Times article found that if surgical teams follow a checklist, there is a higher survival rate for patients. The changes are easy to make and have virtually no cost to the hospital. Massachusetts attorney Thomas M. Kiley, http://www.tomkileylaw.com, has investigated wrongful death lawsuits and he thinks this checklist can actually save lives.
The article by Eric Nagourney, reports on research published in The New England Journal of Medicine that said that "complications in surgery are a considerable cause of death and disability around the world. They are devastating to patients, costly to health care systems, and often preventable." http://www.nytimes.com/2009/01/20/health/20surgery.html?-r=1
After surgical teams at eight hospitals adopted a 19-item checklist, the average patient death rate fell more than 40 percent and the rate of complications fell by about a third, the researchers reported. Data was collected from 7688 patients – 3733 before and 3955 after the checklist was introduced. The study was carried out in hospitals in both high and lower income settings—in Ifakara (Tanzania), Manila (Philippines), New Delhi (India), Amman (Jordan), Seattle (United States of America), Toronto (Canada), London (United Kingdom) and Auckland (New Zealand). The reductions in complications proved to be of equal magnitude in high and lower income sites in the study.
The safe surgery checklist, which was launched by WHO, as a recommended guideline for safe practice last year, has since gained global recognition by operating theatre staff, including surgeons and anesthetists. It requires only a few minutes to complete at three critical points during operative care – before anesthesia is administered, before skin incision and before the patient leaves the operating room. It is intended to ensure the safe delivery of anesthesia, appropriate prophylaxis against infection, effective teamwork by the operating room staff and other essential practices in perioperative care.
What part of the checklist is so effective, and how can patients tell if their hospital has adopted this method? Dr. Atul A. Gawande of the Harvard School of Public Health, the senior author of the study, said the researchers don’t really know which items on the checklist made the most difference. It may be that the teams knew they were being studied and were more careful. It may be a combination of all of the items on the checklist that makes a difference, rather than any one item alone. The emphasis on safer procedures may have brought about a broader change in behavior that improved safety, the researchers said.
One of the first things on the checklist is for the team to confirm the identity of the patient and the type of procedure required. After the surgery, the doctors and nurses are supposed to review the surgery, discuss special steps to aid recovery, and confirm that no tools or equipment has been left inside the patient.
Another item on the checklist required members of the surgical team to say who they are and what they do before the surgery started. Research has shown that sometimes junior team members are reluctant to speak up during surgery and communication problems are common. The simple act of declaring who they are gave them the courage to speak up later.
Some of the items on the checklist seem like common sense, like requiring confirmation that all tools and equipment are present and sterilized and ready for surgery. The checklist requires that the surgical team verify that there is enough blood available and that the equipment measuring blood oxygenation is working, and that all medical images needed are available to the team. The nursing staff also is required to confirm that the patient has been given antibiotics before the surgery to reduce the chance of infection.
Some of the hospitals in the study have already begun using the checklist regularly, the researchers said. Patients who are concerned, can bring a copy of the New York Times article to their surgeon and ask if the checklist be implemented. Or they can contact the hospital where their surgery is scheduled and ask if the checklist has been adopted.
"These findings have implications beyond surgery, suggesting that checklists could increase the safety and reliability of care in numerous medical fields," Dr Gawande said. "The checklists must be short, extremely simple, and carefully tested in the real world. But in specialties ranging from cardiac care to pediatric care, they could become as essential in daily medicine as the stethoscope.”
