More Evidence Supports the Use of Surgical Checklists

Findings from a new study show that implementing checklists can help reduce surgical complications and in-hospital mortality, adding further evidence of their effectiveness in the hospital setting.

Although “adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses,” the majority of surgical safety interventions have focused on the operating room. Because more than half of all surgical errors occur outside the operating room, investigators in the SURPASS Collaborate Group hypothesized that a more substantial improvement in outcomes can be realized by targeting the entire surgical pathway.

In the study, which is published in the New England Journal of Medicine, lead author Eefje N. de Vries, MD, PhD, and colleagues examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist that included items such as medication, marking of the area (or side of the body) being operated, and use of postoperative instructions. The checklist was implemented in six hospitals based in The Netherlands from 2007 to 2009; the rate of complications during a baseline period of three months was compared with the rate during a 3-month period after the checklist was incorporated.

In a comparison of the cohort 3,760 patients observed before implementation of the checklist with the cohort of 3,820 patients observed after implementation, the total number of complications per 100 patients decreased by one-third, going from 27.3 to 16.7, for an absolute risk reduction of 10.6. The proportion of patients with one or more complications decreased from 15.4% to 10.6%, while in-hospital mortality rates were cut in half, going from 1.5% to 0.8%, for an absolute risk reduction of 0.7 percentage points. Outcomes did not change in the control hospitals, they found.

Researchers concluded that “implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care."

To access the study—Effect of a Comprehensive Surgical Safety System on Patient Outcomes—click here.

Click here to read the accompanying NJEM editorial, Strategies for Improving Surgical Quality—Checklists and Beyond, written by John D. Birkmeyer, MD.

For more:

• Teamwork and Checklists Improve Surgical Outcomes
• World Health Organization (WHO) Surgical Safety Checklist

Has your facility implemented a surgical checklist system? If so, what type of outcomes have you experienced?