Checklists Cut Surgery Death Rates
The simple act of following a checklist has cut the surgery death rate in half and complications by more than a third in a large international study of how to avoid blatant operating room mistakes.
"I was blown away," said Dr. Atul Gawande, a Harvard surgeon and medical journalist who led the study, published in Thursday’s New England Journal of Medicine.
U.S. hospitals have been required since 2004 to take certain surgery precautions, but the 19-item checklist used in the study was far more detailed than what is required.
The researchers estimated that implementing the longer checklist in all U.S. operating rooms would save at least $15 billion a year.
"Most of these things happen most of the time for most patients, but we need to make it so that all these things happen all the time for all patients, because each slip represents an opportunity for harm," said Dr. Alex Haynes of the Harvard School of Public Health, one of the study’s authors.
The checklist was developed by the World Health Organization and includes measures like marking the body part of the person to be operated on before anesthesia.
Also, researchers warn everyone in the operating room to know one another, discuss their roles during the operation, and confirm that all the needed X-rays and scan images are in the room.
They also said to make sure all the needles, sponges and instruments are accounted for after surgery.
The biggest decreases were in developing countries, with the combined death rate for Jordan, India, Tanzania and the Philippines falling 52 percent.
"What we’re seeing is the benefits of good team work and coordinated care," Haynes said.
The results were so dramatic that Dr. Peter Pronovost, a Johns Hopkins University doctor who proved in a highly influential study a few years ago that checklists could cut infection rates from intravenous tubes, said he was skeptical of the findings.
He pointed to one possible flaw, "You had people who bought into the system collecting their own data."
The 19-point checklist is already being adopted. Ireland, Jordan, the Philippines and Britain have recently established nationwide programs to have the checklist used in all operating rooms.
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