Hospital Checklists Reduce Surgical Complications,
WEDNESDAY, Nov. 10 (HealthDay News) -- Hospitals that used
checklists to prevent errors involving surgical patients
dramatically reduced both complications and in-hospital deaths, a
new study finds.
Between 2007 and 2009, six hospitals in the Netherlands
implemented a series of 11 checklists that covered every aspect of
surgical care from the moment the patient arrived at the hospital
The checklists included about 100 items, covering pre-operative
care, the operating room itself, recovery or intensive care and
post-operative care. Items to be checked off included everything
from making sure blood was available during surgery,
double-checking that surgeons were operating on the correct site,
and making sure the staff in the recovery ward or intensive care
was clear on how to take care of the patient after surgery,
including proper medications and when a patient should be allowed
to eat again.
A comparison of about 7,600 patients -- half of whom underwent
surgery before the checklists were being used and half who had
surgery after implementation of the checklists -- found that
checklists reduced complications by one-third. In-hospital deaths
were cut in half.
"A comprehensive checklist for surgical patients that covers the entire surgical tract from admission to discharge was able to decrease mortality by half and morbidity by one-third," said study senior author Dr. Marja Boermeester, an associate professor and gastrointestinal surgeon at the Academic Medical Center in Amsterdam.
The study is published in the Nov. 11 issue of the
New England Journal of Medicine.
Surgical errors remain a major concern in U.S. hospitals. A
study published in October in the
Archives of Surgery found that serious, devastating errors,
such as operating on the wrong patient or the wrong body site, can
and do occur. Many of the mistakes cited in that report occurred
due to simple errors in judgment or because surgical teams had
failed to perform standard pre-operation checks.
To reduce errors, hospitals are increasingly turning to
checklists -- and a growing body of research shows they work.
A study in the Oct. 20 issue of the
Journal of the American Medical Association found that a
program at 108 Veterans Administration hospitals that involved pre-
and post-surgical debriefings as well as checklists reduced deaths
by 18 percent.
In the new study, all participating hospitals, which included
both academic and teaching hospitals, were highly regarded before
implementation of the checklists, showing that even high-performing
hospitals can benefit, Boermeester noted.
After implementing the checklists, complications fell from 27.3
per 100 patients to 16.7 per 100. The proportion of patients with
one or more complications fell from 15.4 percent to 10.6 percent,
while the in-hospital death rate fell from 1.5 percent to 0.8
Patient outcomes did not change at hospitals used as
Dr. John Birkmeyer, a surgeon and director of the Center for
Healthcare Outcomes and Policy at the University of Michigan, said
the study provides strong evidence that checklists aren't merely a
good idea, but something that all hospitals should be using as a
"This study confirms previous research that showed the use of checklists can have a dramatic effect in both reducing the risk of dying after surgery and suffering other types of complications," Birkmeyer said. "There is enough evidence that has accrued about the effectiveness of checklists that I believe they have crossed a threshold beyond just being a good idea and to becoming a standard of surgical care."
Not only did the checklists reduce the specific complications
targeted by line items on the checklist (such as having blood
available or giving the right antibiotics before surgery), but they
reduced all types of complications after surgery.
"This implies checklists work less because of specific content, but more because of the indirect effects on teamwork, communication and other aspects of safety culture," said Birkmeyer, who wrote an accompanying editorial in the journal.
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