Surgical Safety Checklist Drops Deaths, Complications

An international pilot study involving the Toronto General Hospital (TGH), a teaching hospital affiliated with the University of Toronto, and other hospitals from around the world, has found that using a Surgical Patient Safety Checklist significantly reduces surgical complications and mortality. The study, led by the World Health Organization and Dr. Atul Gawande of the Harvard School of Public Health, appears in the New England Journal of Medicine's "Online First" on Jan. 14, 2009 (www.nejm.org). The study will appear in the journal's printed issue on Jan. 29, 2009.

"We know that many surgical complications are preventable," said Dr. Bryce Taylor, University Health Network's Surgeon in Chief, who co-authored the study for TGH. "With approximately 234 million surgeries performed each year worldwide, we owe it to our patients to look at every opportunity to prevent complications during and after surgery."

Studies in industrialized countries have found that major complications occur in three to 16 percent of inpatient surgeries and a perioperative death rates for inpatient surgery of 0.4 to 0.8 percent. Inconsistent approaches to surgery can also lead to adverse events. For example, the study finds there is strong evidence to support using antibiotics within one hour prior to incision as a prophylaxis to reduce the possibility of wound infections. Yet, surgical teams around the world are inconsistent in their approaches.

Launched in October 2007, TGH and seven hospitals located in cities around the world (New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, United Republic of Tanzania; London, UK; and Seattle, USA) were selected by the WHO and Harvard to pilot a Surgical Patient Safety Checklist as part of the WHO’s "Safe Surgery Saves Lives" initiative. Developed by an international group made up of leading surgeons, nurses, anesthesiologists and patient safety experts, the WHO Checklist was influenced by checklists used in the airline industry to reduce the incidence of airline errors.

Using the checklist, the study found the following overall results:

  • The rate of major complication in the study operating rooms fell from 11.0 percent in the baseline period to 7.0 percent after the introduction of the Checklist--a reduction of more than one-third.
  • Inpatient deaths following operation fell by over 40 percent (from 1.5 percent to 0.8 percent) with the implementation of the checklist.
  • Similar reductions in complications were seen in both the high income and lower income sites in the study, with rates falling from 10.3 percent to 7.1 percent and 11.7 percent to 6.8 per cent respectively.

"The WHO agenda is a bold one, attempting to roll out a safety checklist worldwide," said Dr. Richard Reznick, University of Toronto's chair of Surgery, UHN's vice president of Education and co-author of the study. "These initial and very positive results will be a huge stimulus for all countries to consider making this type of safety checklist approach a regular aspect of surgical care."

For information, visit www.who.int/patientsafety/safesurgery/en/index.html.

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