Results show surgical safety checklist drops deaths and complications by more than one third

Jan 14, 2009

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 (WHO) and Dr. Atul Gawande of the Harvard School of Public Health, appears in the New England Journal of Medicine's Online First on Wednesday, January 14, 2009. The study will appear in the journal's printed issue on January 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 3 to 16 per cent of inpatient surgeries and a perioperative death rates for inpatient surgery of 0.4 to 0.8 per cent. Inconsistent approaches to surgery can also lead to adverse events. For example, 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.

TGH was the only hospital in Canada and one of only two hospitals in North America involved in the pilot study. Led by Dr. Taylor, UHN's Surgical Program is one of the largest in Canada with 23,000 inpatient and outpatient surgeries performed in 2007/08.

The Checklist is intended to improve communications amongst members of the surgical team during surgery and to increase the consistency in using proven standards of surgical care in order to reduce preventable complications and mortality. At three critical points during surgery (prior to anesthesia, immediately prior to incision, and prior to patient exiting the operating room), a member of the surgical team verbally confirms the completion of each step for infection prophylaxis, anesthesia safety and other essential steps in surgery (ex. confirming that the surgery site is marked, counting the number of sponges and instruments used at the end of surgery to ensure nothing has been left inside of the patient).

Each pilot site implemented the Checklist in their operating rooms and tracked changes in the rate of inpatient complication or death within 30 days of surgery. To establish a baseline, data was collected from a total of 3,733 patients before the implementation of the Checklist and 3,955 patients after it was introduced. The TGH surgical team adapted the WHO's Checklist to reflect our surgical practice. The Checklist was used at TGH's 11 operating rooms during a variety of outpatient and inpatient surgeries.

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


The rate of major complication in the study operating rooms fell from 11.0 per cent in the baseline period to 7.0 per cent after the introduction of the Checklist - a reduction of more than one-third.
Inpatient deaths following operation fell by over 40 per cent (from 1.5 per cent to 0.8 per cent) 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 per cent to 7.1 per cent and 11.7 per cent 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."

"Like an airline pilot, the surgeon is only one member of an entire surgical team. Using the Checklist, we can improve communications during surgery to make sure everyone is on the same page and to use proven standards in every single operation to reduce the risks to patients," said Dr. Taylor. "We are now using the surgical checklist at UHN's Toronto General, Toronto Western and Princess Margaret Hospitals to ensure the highest possible standards in our operating rooms."

Journal: www.nejm.org

Source: University Health Network

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

Pilot safety protocol could help dentists reduce errors

Aug 02, 2010

Pilots and dentists have more in common than one might think: Both jobs are highly technical and require teamwork. Both are subject to human error where small, individual mistakes may lead to catastrophe if not addressed ...

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

User comments : 0

More news stories

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Researchers discover target for treating dengue fever

Two recent papers by a University of Colorado School of Medicine researcher and colleagues may help scientists develop treatments or vaccines for Dengue fever, West Nile virus, Yellow fever, Japanese encephalitis and other ...

Our brains are hardwired for language

A groundbreaking study published in PLOS ONE by Prof. Iris Berent of Northeastern University and researchers at Harvard Medical School shows the brains of individual speakers are sensitive to language univer ...

Study recalculates costs of combination vaccines

One of the most popular vaccine brands for children may not be the most cost-effective choice. And doctors may be overlooking some cost factors when choosing vaccines, driving the market toward what is actually a more expensive ...

Better thermal-imaging lens from waste sulfur

Sulfur left over from refining fossil fuels can be transformed into cheap, lightweight, plastic lenses for infrared devices, including night-vision goggles, a University of Arizona-led international team ...

Hackathon team's GoogolPlex gives Siri extra powers

(Phys.org) —Four freshmen at the University of Pennsylvania have taken Apple's personal assistant Siri to behave as a graduate-level executive assistant which, when asked, is capable of adjusting the temperature ...