Checklist cuts death rate for urgent surgery

NEW YORK Fri May 21, 2010 5:22pm EDT

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NEW YORK (Reuters Health) - A simple checklist helps surgical teams avoid mistakes and cuts deaths by more than half during urgent surgery, a new study shows.

The checklist tested in the new study was introduced in 2008 by the World Health Organization as part of its Safe Surgery Saves Lives program.

It had already been shown to cut complications across all types of surgery, but there had been concern that when time is of the essence, running through a checklist might waste life-saving minutes.

But that wasn't the case, said Dr. Atul A. Gawande, a surgeon at Brigham and Women's Hospital in Boston, Massachusetts, who worked on the study. Gawande has also written about checklists for The New Yorker magazine, where he is a staff writer, and in his 2009 book The Checklist Manifesto: How to Get Things Right.

"It has a kind of counterintuitive feel to it," he said. But in fact, "the teams did better when they took those two minutes to run through the checks."

Gawande and colleagues tested eight different hospitals around the world before and after they introduced the WHO checklist. Of the more than 1700 patients who had urgent surgery -- for instance, for open fractures -- the number of deaths dropped by almost two-thirds, from 3.7 percent to 1.4, they report in the Annals of Surgery.

In addition, the number of surgical complications fell by more than a third.

It's not the first time that jotting down a few basic steps, and following them, has been shown to have a dramatic impact on healthcare: Five simple checkpoints for intensive-care personnel -- one as simple as washing your hands -- saved Michigan State more than $100 million and 1500 lives over a year and a half.

Although it isn't clear what steps are the most important in the checklist, simple things like knowing each other's name could make a big difference, said Gawande, who heads WHO's Safe Surgery Saves Lives program.

"What the checklist pushed the clinicians to do and the systems to do is to become more team-focused," said Gawande. "All of our indications so far are that the team components ... are just as important as making sure that blood and antibiotics are available."

SOURCE: here ffect_of_A_19_Item_Surgical_Safety_Checklist.28.aspx Annals of Surgery, May, 2010.

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