Checklist to Improve Communication Drives Down Post-surgery Mortality
May 3rd, 2017
BOSTON — The relatively simple act of using a safe surgery checklist has helped South Carolina hospitals reduce post-surgical mortality by 22%.
An online report in Annals of Surgery touts the effort — which involved hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist — as the first to demonstrate large-scale population-wide effect of the checklist.
"That is a major reduction in post-surgical mortality and it demonstrates that when done right, the Surgical Safety Checklist can significantly improve patient safety at large scale," explained lead author Alex B. Haynes, MD, MPH, associate director of the Ariadne Labs Safe Surgery Program and a surgeon at Massachusetts General Hospital. Those groups worked with the Harvard T.H. Chan School of Public Health and the South Carolina Medical Association to implement the program.
The 19-item checklist is designed to prompt surgical team discussion of the surgical plan, risks, and concerns. The basic checklist, which can be customized, is divided into three sections: before induction of anesthesia, before skin incision, and before patient leaves operating room. It has specific questions about patient issues, such as known allergies and difficult airway concerns, as well as questions for professionals involved — including surgeons, anesthesia professionals, and nurses. The last section prompts the surgical team to check for issues, such as missing items that might have been left in the patient, and to review recovery and management plans.
With all hospitals in the state invited to participate in a 12-step implementation program that included customized checklists, 14 hospitals representing nearly 40% of the state’s inpatient surgery volume signed up. Ultimately, the 30-day post-surgery mortality outcomes at those hospitals were compared to non-participants.
Looking at a broad range of surgeries, the study determined that the post-surgery death rates in the 14 hospitals that completed the program was 3.38% in 2010 prior to implementation, but fell to 2.84% in 2013, post-implementation. In the other 44 hospitals in the state, mortality rates were 3.5% in 2010 and rose slightly to 3.71% in 2013.
"Safety checklists can significantly reduce death in surgery. But they won't if surgical teams treat them as just ticking a box," said co-author Atul Gawande, MD, MPH, of Ariadne Labs. "With this work, South Carolina has demonstrated that surgery checklists can save lives at large scale — and how hospitals can support their teams to do it."