Performing a Surgical Checklist Saves Lives

A two-minute safety checklist for surgeons could dramatically reduce the risk of deaths and injuries caused by failed operations, a new study suggests.

Researchers at St Mary's Hospital (London; United Kingdom) collected data for 3,733 patients who were operated on before the World Health Organization (WHO, Geneva, Switzerland) 19-point surgical safety checklist was introduced, and compared this with data for 3,955 patients operated on after the checklist was brought in. The results showed that 11% of patients suffered complications before the checklist was introduced, but this fell to 7% after introduction of the checklist - a fall of more than a third (36%). Similarly, the death rate of patients in the first 30 days after surgery, which was 1.5% before the list was introduced, was reduced to 0.8% afterwards, a drop of 47%. The study describing the practical challenges of introducing the WHO surgical checklist were published early online on January 13, 2010 issue of BMJ.

"The beauty of the surgical safety checklist is its simplicity, and as a practicing surgeon I would urge surgical teams across the country to use it,” said study coauthor and former U.K. Health Minister Lord Ara Darzi of Denham, M.D., who helped develop the checklist. "The items in the checklist are not new, they are things that surgical teams should be doing already; but modern surgery involves technology as complicated as that in the cockpit of an airplane. When people first flew they did not need checklists but there comes a point when you recognize that to err is human, and in surgery errors can have terrible consequences.”

The checklist involves several procedures, beginning with a roll call, where all team members confirm their name and role. The senior nurses, surgeon, and anesthetist then confirm the patient, site, and procedure. Nursing teams will also provide a sterility report and highlight any potential concerns about equipment. After the operation and before the patient leaves the operating room, the nursing team must verbally confirm that the name of the procedure has been recorded, that instrument, sponge, and needle counts are recorded, how the specimen is labeled (including patient name), and whether there are any equipment problems. To ensure that postoperative patient management is proper, surgeons, anesthetists, and nurses should then discuss any concerns about the patient's recovery and ongoing treatment.

Related Links:
St Mary's Hospital
World Health Organization