Surgical checklists might cut malpractice claims

NEW YORK Fri Jan 14, 2011 11:08am EST

Surgeons perform a laparoscopic gastric bypass, with five ports inserted in a semi-circle on Carolyn Dawson inflated abdomen, at Rose Medical Center, in Denver August 30, 2010. REUTERS/Rick Wilking

Surgeons perform a laparoscopic gastric bypass, with five ports inserted in a semi-circle on Carolyn Dawson inflated abdomen, at Rose Medical Center, in Denver August 30, 2010.

Credit: Reuters/Rick Wilking

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NEW YORK (Reuters Health) - Surgical checklists not only save lives by preventing medical errors, they could also make a big dent in medical malpractice claims, Dutch researchers say.

Scouring data from the largest medical liability insurer in the Netherlands, they found nearly a third of the claims arose 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 estimated it costs the U.S. more than $55 billion annually, or 2.4 percent of the country's healthcare spending.

In addition, experts say tens of thousands of Americans die every year due to medical errors -- most of which are related to surgery, according to the Dutch report.

Earlier studies have shown that when healthcare providers follow a checklist, they reduce those deaths dramatically. And they could save money, too, 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," said Dr. Atul Gawande of the Harvard School of Public Health in Boston, a surgeon who has written extensively on the topic.

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

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."

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

It includes simple 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 happen.

"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 29 percent of the reasons something had gone wrong corresponded to an item on the checklist, such as marking the patient or communication between hospital staff.

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

While there is no guarantee the checklist would actually have averted those deaths had it been used at the time, the researchers say 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.

SOURCE: Annals of Surgery, online January 4, 2011.

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Comments (2)
DrJJJJ wrote:
LIMIT LAWSUITS! Lawsuit are the primary driver of healthcare cost increases-we’re sue crazy folks! Anything to help reduce suits is big news!

Jan 14, 2011 1:27pm EST  --  Report as abuse
LynnJ wrote:
My husband caught a prep nurse marking the wrong knee for arthroscopic surgery and averted a mistake; he also refused a major trank given to him instead of his regular medication – we never found out where either error originated – and I saved his life in an ER in which no one was attending to him – his BP dropped dangerously when his appendix was allowed to rupture and he went into septic shock. Told the Quality Assurance officer afterward that it was most discomfiting to know more than the doctor in the ER – who assured me my husband was “dehydrated” when they started forcing the needed IV fluids.

Surgeons and nurses and pharmacists are people, and people make mistakes. ANYthing that can prevent 33% of these errors and improve outcomes for patients should be implemented. It’s a no-brainer that this should reduce the terrible costs of malpractice for patients AND medical facilities/personnel – including liability insurance bills that have pushed many qualified docs out of business.

But of course the pols will say that implementing such checklists is interference with doctors’ rights to treat their patients as they please, the way they have screamed about mandates for other evidence-based treatment protocols. They would rather pander to the fears of their constituents about “government take-overs” of medicine than do what is right.

Jan 14, 2011 2:29pm EST  --  Report as abuse
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