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Surgical Checklist Can Reduce Deaths by Half

Jan 15, 2009 | Parker Waichman Alonso, LLP

A new study has concluded that a checklist referred to in collaboration with surgical procedures can significantly reduce deaths from surgical errors.  Pointing out that airline pilots use similar tools, which have been proven to make flying safer, the National Post reports that using such lists prior to, during, and after surgery can drastically reduce the risk of serious complications and fatalities by at least on-third.

The international study was published yesterday by a variety of hospitals said National Post and appears in the New England Journal of Medicine, said The Canadian Press.  According to The Canadian Press, the number of preventable deaths numbers at around 1.5 million annually with an astounding 10 million people internationally being spared surgical complications if use of a simple 19-step checklist is employed.  Patient safety experts in Canada are working with hospitals there to implement the checklist, which was devised in cooperation with the World Health Organization last summer.

TopNews said 7,500 noncardiac patients in eight hospitals in Toronto, Seattle, London, New Delhi, Amman, Auckland, Manila, and Ifakara were studied; Harvard’s Dr. Alex B. Haynes led the study.  Half the patients underwent surgery with and the other half without the checklist, said TopNews.  The aim of the study was to see whether or not covering the items on the checklist at points during the procedures would result in saved lives and decreased complications.  The researchers that when the list was followed, surgery-related fatalities dropped by an astounding 40 percent while post-surgical complications fell by 36 percent, said The Canadian Press.

The study specifically reviewed about 500 procedures conducted with and 500 conducted without the checklist and found that the 1.5 percent death rate before the checklist was introduced dropped to 0.8 percent when the checklist was used, said The Canadian Press.  Also, with the checklist, complication rates dropped to seven—from 11—percent, surgical site infections dropped from 6.2 to 3.4 percent, and unplanned operating room returns dropped from 2.4 to 1.8 percent.

"It does take a couple of minutes.  And that couple of minutes will be paid back in dividends," Phil Hassan, CEO of the Canadian Patient Safety Initiative, told The Canadian Press, adding, "It's cost-saving to the hospital but it's also beneficial to the patient, which is really a win-win, right?"  Dr. Bryce Taylor, University Health Network's surgeon-in-chief, told The Canadian Press that, "As soon as we were through the study I was convinced enough about this that the next month we introduced it at Princess Margaret Hospital ... and then the month after that we introduced it at Toronto Western Hospital … So, since about last April, almost a year now, we have been using it for all 23,000 operations here at UHN every year that we do. It is standard practice now."

The checklist is a three-part document that involves steps along the course of surgery:  Prior to administering anesthesia, prior to making the incision, and prior to exiting the patient from the operating room, said The Canadian Press.  Some steps, noted the paper, were very simple such as having the surgical team introduce themselves to each other and ensure they all agree on what surgery will be performed; confirming if the patient has allergies, if blood has been ordered in the event a transfusion is needed, and if antibiotics are needed and have been administered; ensuring surgical tools have been traced; and correctly labeling surgical specimens.