Surgery checklists could save lives, study reveals

• by admin
• 2009-01-19 12:01:30
• General Posting
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I recently read this article in the National Post and thought I would share it. The idea is so simple, I had just assumed it was automatically being done.

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Airline pilots have used them for years as a proven method to make flying less dangerous. Now there is evidence that surgical staff can dramatically curb the amount of harm they inadvertently do to patients simply by working through checklists before, during and after operations.

Employing a standard checklist slashes the number of serious complications and deaths from surgery by more than a third, an international study published Wednesday by hospitals in Toronto and seven other cities concluded.

The concept could have a huge impact if incorporated into all two million operations performed yearly in Canadian hospitals, experts said Wednesday.

"That translates to something like 60,000 people who have operations and would be spared complications," said Dr. Bryce Taylor, chief surgeon at Toronto's University Health Network. "That's a pretty impressive number for something that doesn't cost you anything to do."

And the researchers say their findings, published in the New England Journal of Medicine, could be applied to many other areas of health care, as well.

Toronto General, one of the network's hospitals, was part of the eight-city study spearheaded by the World Health Organization (WHO). To inspire his doctors and nurses, Dr. Taylor at one point had a senior Air Canada training pilot speak to them about the concept.

Experts urged yesterday that the idea -- which they called inexpensive and relatively simple -- be implemented by all Canadian hospitals as soon as possible.

Patient safety has become an increasingly pressing issue in the wake of research that highlighted the problem of medical error, or "adverse events," as they are called in the system. A 2004 study estimated that 9,000 to 23,000 people die in Canadian hospitals annually because of preventable adverse events, out of 2.5 million yearly admissions.

Of those errors, the largest number occur during or after surgery, said Dr. Ross Baker, a University of Toronto health policy professor who co-authored the 2004 study.

"It is one of the areas where we have tremendous skills and resources," Dr. Baker said. "And then we go in and somebody forgets to do something they should do as a matter of course, and the outcome is an infection or complication of some sort."

The WHO checklist requires surgeons, anesthetists and nurses to pause at three points: before anesthesia is administered, before the first incision and before the patient is taken out of the operating room.

Staff orally verify each time that a number of precautions has been taken. They ensure, for instance, that the right patient is on the gurney and the correct body part is being operated on; that antibiotics have been administered within an hour of the first incision; and that all instruments are accounted for at the end of the operation -- and none is left inside the patient.

The study monitored 3,733 patients who underwent their operation before staff started using the checklist, and 3,955 whose surgeries incorporated use of the measure. The rate of serious complications -- from cardiac arrest to acute kidney failure and septic shock -- dropped to 7% of operations from 11%, a reduction of more than a third. The fatality rate fell by almost half, to .8% of surgeries, or 31 deaths.

The results were similar in both affluent and developing countries.

Dr. Taylor said there was some reluctance at first to implement the idea. The operating room culture is a traditional one where the surgeon is the "capa gruppo," the group boss, he noted. The checklist concept encourages a team effort, where all have their say.

"If one of the nurses in the OR is afraid to speak up, then the team is in trouble," Dr. Baker said. "That's the lesson we learned in aviation. When the pilots were God, then the planes crashed. When the junior person could speak up, they discovered they could have a much safer environment."

Phil Hassen, CEO of the Canadian Patient Safety Institute, said his organization is contacting provincial health departments and taking other measures to encourage wide adoption of the idea, which he said could have significant benefits for patients.

Dr. Michael Baker, who advises the Ontario government on patient safety, said he and colleagues will look at whether parts of the WHO concept should be made mandatory, but expects the idea will be taken up voluntarily by most surgeons.

"It's just so convincingly helpful," he said.

Tom Klassen, head of the Ontario Hospital Association, said he would like to see the idea tested in more hospitals before it is implemented universally.