Score another victory for the humble checklist. Adopting a surgical safety checklist reduced deaths and complications by more than a third in a study published online by the New England Journal of Medicine this week.
The 19-item list, developed by the World Health Organization, is pretty straightforward stuff. At various points in the procedure, team members confirm that they're doing the right thing on the right part of the right patient, that they're prepared for certain high-risk situations that might arise, and that key issues regarding post-op care are clear. (See the checklist by clicking on the PDF icon.)
But straightforward can be a good thing — especially if it encourages clear, systematic communication and behavior.
Researchers collected data on nearly 8,000 patients who were operated on in eight hospitals scattered around the world. As a basis for comparison, about half the patients underwent surgery before the checklist was adopted. The death rate fell from 1.5% to 0.8%, and the rate of inpatient complications fell from 11% to 7%.
The hospitals were located in both low-income countries such as India and Jordan, and high income countries, such as the U.S. and England. All of the hospitals saw declines in complications, and all except one saw a decline in deaths, though not all the shifts were statistically significant at the level of individual hospitals.
Atul Gawande, the maddeningly polymathic surgeon/writer/policy wonk who is corresponding author on the study, has published on checklists before. In 2007, he wrote a New Yorker article about the work of Peter Pronovost in using a simple checklist to prevent infections and save lives in the ICU.
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