Checklist helps reduce surgical complications, deaths
Surgical adverse events reduced by one third in trials in eight
countries
14 January 2009 –- Hospitals in eight cities around the globe have
successfully demonstrated that the use of a simple surgical checklist,
developed by WHO, during major operations can lower the incidence of
surgery-related deaths and complications by one third.
The studies were undertaken in hospitals in each of the six WHO
regions. Analysis shows that the rate of major complications following
surgery fell from 11% in the baseline period to 7% after introduction
of the checklist, a reduction of one third. Inpatient deaths following
major operations fell by more than 40% (from 1.5% to 0.8%).
"The concept of using a brief but comprehensive checklist is
surprisingly new to us in surgery. Not everyone on the operating teams
were happy to try it. But the results were unprecedented. And the
teams became strong supporters," said Dr Atul Gawande, main author of
the study and team leader for the development of the WHO surgical
safety checklist.
Data was collected from 7688 patients – 3733 before and 3955 after the
checklist was introduced.
The study was carried out in hospitals in both high and lower income
settings—in Ifakara (Tanzania), Manila (Philippines), New Delhi
(India), Amman (Jordan), Seattle (United States of America), Toronto
(Canada), London (United Kingdom) and Auckland (New Zealand). The
reductions in complications proved to be of equal magnitude in high
and lower income sites in the study.
Implications for other medical fields
“These findings have implications beyond surgery, suggesting that
checklists could increase the safety and reliability of care in
numerous medical fields,” Dr Gawande said. “The checklists must be
short, extremely simple, and carefully tested in the real world. But
in specialties ranging from cardiac care to paediatric care, they
could become as essential in daily medicine as the stethoscope."
The safe surgery checklist, which was launched by WHO as a recommended
guideline for safe practice last year, has since gained global
recognition by operating theatre staff, including surgeons and
anaesthetists.
It requires only a few minutes to complete at three critical points
during operative care – before anaesthesia is administered, before
skin incision and before the patient leaves the operating room. It is
intended to ensure the safe delivery of anaesthesia, appropriate
prophylaxis against infection, effective teamwork by the operating
room staff and other essential practices in perioperative care.
"The immediate response to the checklist has been remarkable, and the
studies undertaken in the pilot hospitals are significant. They will
make a major contribution towards our goal of having 2500 hospitals
around the world using the safe surgery checklist by the end of this
year," said Sir Liam Donaldson, Chair of the WHO World Alliance for
Patient Safety and Chief Medical Officer for England.
The results of the study are published on the web site of the New
England Journal of Medicine. The material will appear in the the
journal’s printed issue on 29 January 2009.
For more information please contact:
Dan Epstein
WHO News Team Leader
WHO, Geneva
Telephone: +41 22 791 1492
Mobile: +41 79 475 5534
E-mail: epstei…@who.int
Vivienne Allan
Patient Safety Programme
WHO, Geneva
Mobile: +41 79 615 5065
E-mail: alla…@who.int
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