How hard can this be?

January 27th, 2009 | Sources: NEJM, Washington Post

Using simple, cockpit-style checklists in operating rooms cuts mortality and complications by 40%, according to a study published in the New England Journal of Medicine.

The 19-item cheat sheets had tick-boxes for pre-operative activities including confirming the patient’s name and allergy history, and confirming equipment had been sterilized and prophylactic antibiotics had been administered.

Post-operative checks included specimen labeling and tool and equipment retrieving.

The one-year study of non-cardiac surgery involved 7,600 patients in urban and rural hospitals in 8 countries with locations including London, Seattle, Manila, New Delhi and Ifakara, Tanzania.

Hospitals using the checklists observed declines in serious complications from 11% to 7%. The highest reductions were noted in rural and underfunded hospitals.

“You take something as complex as surgery, and you think there isn’t a lot that can be done to make it better,” Atul Gawande told the Washington Post. The Brigham and Women’s hospital physician added, “a checklist seems like a no-brainer, but the size of the benefit is dramatic.”

The authors speculate that if all US operating rooms implemented the checklists, the US health system would save $15-25 billion per year by not having to treat avoidable complications.

Recent studies have shown that the average surgical complication in the US costs $12,000 to treat, and nearly half are preventable.

Worldwide, over 234 million surgical procedures are performed annually, and somewhere between 3 and 17% result in a major complication.

“We’re not great at doing the simple things all the time,” concluded Gawande. “If you miss a few percent here and a few percent there, it adds up.”

“I don’t get through a week where (the checklist) has not caught something,” he marvelled.


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