Surgery Checklist Works, but Benefits Vary

Reuters Health Medical News

December 19, 2011

A surgical checklist can lower patient death rates, a study at one hospital confirms—although the drop was smaller than past research has found.
About 100,000 hospitals worldwide now use the surgical safety checklist developed by the World Health Organization (WHO). The list has 19 items the surgical team checks right before and after a patient’s procedure. That includes making sure they have the right patient, are operating on the correct body site and are aware of the patient’s allergies.
A 2009 study of eight hospitals in different countries found that in the year after the centers adopted the WHO checklist, the overall death rate among surgery patients dropped from 1.5% to 0.8%.
But researchers at University Medical Center Utrecht in the Netherlands found a significantly smaller effect at their hospital. They reported online Nov. 24 in Annals of Surgery that surgical mortality went from 3.1% to 2.8% in the year and a half after the hospital adopted the WHO checklist.
But a lot depended on surgical teams’ actually completing the checklist. Mortality was about two-thirds lower in patients with fully completed checklists, but the lists were completed for only 39% of patients, the researchers said. “Checklist compliance was clearly far from perfect in our hospital,” wrote Wilton A. van Klein, M.D., and his colleagues.
Critically ill patients needing emergency surgery were less likely to have a completed checklist. But that did not seem to explain the lower death risk among patients with fully completed checklists, according to the researchers.
“Mortality was strongly associated with checklist compliance, suggesting that large variations in the level of implementation for different groups of patients need to be reduced,” van Klein’s team wrote.
One possible reason for the smaller effects compared with the 2009 study is differences among hospitals, according to the authors. Their center is a university hospital that tends to get more critically ill patients than a community hospital would. And the overall death rate among surgery patients there was higher than the average seen in the 2009 study, which included a mix of university and community centers.
The current findings are more in line with a recent study of U.S. Veterans Health Administration (VHA) hospitals, according to van Klein’s team. The VHA, which is the largest integrated health system in the United States, has taken steps to cut medical errors, including checklists and special training sessions to promote teamwork among staff.
A study earlier this year found that the number of medical errors at VHA hospitals dropped from 3.2 per month in 2006 to 2.4 in 2009. It’s estimated that across the United States, medical errors occur in about one in 75,000 surgeries every year. Surgical checklists alone are unlikely to be enough without an overall focus on the “safety culture” at hospitals, van Klein’s team wrote.