January 15, 2011

Checklists Save Lives, Thwart Malpractice Claims

Dutch researchers say that surgical checklists not only save lives by preventing medical errors, they could also make a big dent in medical malpractice claims.

The team found that nearly a third of the claims that popped up while scouring data from the largest medical liability insurer in the Netherlands were from mistakes that likely would have been caught by a checklist.

Putting a price tag on the medical liability system is difficult, but one 2010 study found that it costs the U.S. over $55 billion annually, or 2.4 percent of the country's healthcare spending.

According to the Dutch report, experts say that tens of thousands of Americans die every year due to medical errors, most of which are related to surgery.

Earlier studies have shown that when healthcare providers follow a checklist, they reduce those deaths dramatically.  They could also save money by preventing complications that require further treatment.

"This kind of evidence indicates that surgeons who do not use one of these checklists are endangering patients," Dr. Atul Gawande of the Harvard School of Public Health in Boston, a surgeon who has written extensively on the topic, told Reuters.

Gawande said that only a fourth of U.S. hospitals use one of the three checklists that have been proven to work.

If they turn out to curb malpractice lawsuits too, he added, "I don't know what more we want in order for hospitals to adopt the concept."

The researchers identified the main reasons for errors in 294 successful claims related to surgeries from 2004 and 2005 in the current study.  They then compared those to the items on a comprehensive surgical checklist known as SURPASS, which is now used in several hospitals in the Netherlands.

It includes things like making sure the operating schedule is correct, checking that all equipment is available, and marking on which side of the patient the surgery is going to take place.

"While the checklist as a whole may seem a little intimidating, the separate parts for each stage of the surgical pathway take little time to complete," Dr. Eefje de Vries, of the Academic Medical Center in Amsterdam, and colleagues write in the Annals of Surgery.

They found that 29 percent of the reasons something had gone wrong corresponded to an item to the checklist, like marking the patient or communication between hospital staff.

In four of the 10 deaths in the claims database, at least one of the contributing factors was addressed in the checklist.

The researchers say that while there is no guarantee the checklist would actually have averted those deaths had it been used at the time then it would likely have prevented "a considerable amount of damage, both physical and financial."

"These are striking findings," said Gawande, who directs the World Health Organization's Global Challenge for Safer Surgical Care.

He said the liability insurer for his own hospital, Brigham and Women's in Boston, had come to a similar conclusion about the WHO checklist used there.

"The message for hospitals is you want to adopt one of these checklists," said Gawande.


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