Using a Checklist Could Improve Noncardiac Surgical Outcomes

A new study has found that implementation of a surgical checklist is associated with lower death rates and fewer complications in patients who are undergoing noncardiac surgery.

Researchers from the World Health Organization (WHO; Geneva, Switzerland) Safe Surgery Saves Lives study group evaluated the effect on rates of mortality and major complications of implementing the checklist in inpatient surgical units in eight participating hospitals, located in Amman (Jordan); New Delhi (India); Seattle (WA, USA); Ifakara (Tanzania); Manila (The Philippines); Toronto (Canada); London (United Kingdom); and Auckland (New Zealand). Data were prospectively collected regarding clinical processes and outcomes in 3,733 consecutive inpatient noncardiac surgery patients aged 16 years or older. After implementation of the Surgical Safety Checklist, data were collected from a further 3,955 consecutive inpatient noncardiac surgery patients. The primary endpoint was the rate of death and other complications in hospitalized patients during the first 30 days after surgery. The study results showed that the death rate during hospitalization decreased from 1.5% in the initial cohort to 0.8% after implementation of the checklist. The corresponding decline in the rate of any inpatient complication was from 11% to 7%. The study was published in the January 29, 2009, issue of The New England Journal of Medicine (NEJM).

"Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly," concluded lead author Alex Haynes, M.D., MPH, of the Harvard School of Public Health (HSPS, Boston, MA, USA) and colleagues. "Applied on a global basis, this checklist program has the potential to prevent large numbers of deaths and disabling complications, although further study is needed to determine the precise mechanism and durability of the effect in specific settings."

The Safe Surgery Saves Lives initiative is a collaborative effort lead by the HSPS and involves more than 200 national and international medical societies and ministries of health in an effort to meet the goal of reducing avoidable deaths and complications in surgical care. The WHO Surgical Safety Checklist identifies a set of surgical safety standards that can be applied in all countries and health settings. The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: before induction of anesthesia ("Sign In”), before skin incision ("Time Out”) and before the patient leaves the operating room ("Sign Out”). In each phase, a checklist coordinator must be permitted to confirm that the team has completed its tasks before it proceeds with the operation.

Related Links:
World Health Organization
Harvard School of Public Health