Surgical Checklists Save Lives

If you are a busy person—and who isn’t these days?—you probably regularly make lists to remember tasks such as purchasing groceries and running various errands. And, if you are like many of us, you find that things slip your mind if you don’t have them written down.

A recently-completed study, Safe Surgery South Carolina, was conducted voluntarily among our state’s hospitals. The study discovered that the use of checklists made a significant difference in surgical mortality rates. Those hospitals which implemented the World Health Organization’s (WHO) Surgical Safety Checklist saw a reduction in post-surgical fatalities of 22 percent over the hospitals that did not participate. It’s important to note that the non-participatory hospitals experienced an increase in their post-surgical fatality rate during the same period of time.

The Case for Checklists

Did you read Dr. Atul Gawande’s book, The Checklist Manifesto? In it, Gawande made the case that formal checklists improve medical performance and save lives. Gawande, who is a Boston surgeon and the executive director of Ariadne Labs, a Safe Surgery South Carolina (SSSC) project’s sponsor, began studying the problem of surgical deaths over a decade ago. His conclusion was that an entire surgical team should employ checklists to ensure that simple but crucial questions are asked and that certain tasks are performed. In the book, he pointed to other professionals for whom the use of checklists is critical to success and to saving lives, such as airline pilots and those who build skyscrapers.

The theories put forth in Gawande’s book have been borne out by the SSSC project. A 2009 study in which Gawande participated found that surgical outcomes are improved by checklists. One checklist item alone, concerning the administration of appropriate antibiotics, was found to reduce infection at surgical sites by 33 to 88 percent.

The Safe Surgery South Carolina project invited all of SC’s hospitals to join in a 12-step program to implement surgical checklists. By the end of the study, 14 hospitals (40 percent of SC’s total inpatient surgical population) had completed the program and turned in their results. Many major surgical procedures such as cardiac, neurological, and orthopedic surgeries were included in the data.

Once researchers compared the results for post-surgical deaths after 30 days with the rest of the hospitals in SC, they discovered the following:

  • Post-surgical death rates fell from 3.38 percent in 2010 to 2.84 percent in 2013 in the 14 SC hospitals that completed the project.
  • Post-surgical death rates rose from 3.5 percent in 2010 to 3.71 percent in 2013 in the 44 SC hospitals that did not complete the project.
  • These differences added up to a 22 percent mortality rate difference between the two groups of hospitals: those that participated through the end of the study and those that did not.

The effectiveness of the surgical checklist seems to be that it sparks communication among surgical team members. No one on the team needs to make assumptions regarding the status of various surgical steps because communication is dictated by the checklist. Open communication is more or less forced by checklists.

The lead author of the study, Alex Haynes, said, “I’d like to see this type of collaborative in South Carolina lead to collaboratives elsewhere, where we would be able to leverage this knowledge to improve care for patients everywhere.”

The Nuts and Bolts of the SSSC Study

The 19-item WHO checklist is divided into three parts, to correspond with three major stages of any surgery:

  • Before the induction of anesthesia
  • Before the skin incision
  • Before the patient leaves the operating room.

The SSSC study’s details, one of the first to demonstrate the enormous impact of checklists, will be published in August, 2017’s Annals of Surgery.

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Medical malpractice in South Carolina is a politically charged issue, which has led to an extremely complex set of laws in our state governing malpractice lawsuits. If you or someone you care about has been injured by the negligence of a medical professional, you should speak with an experienced South Carolina medical malpractice attorney like the ones at the Louthian Law Firm as soon as possible.

Our attorneys can help you evaluate your case; protect your legal right to the courts, stand by your side throughout the legal process, and get you the best possible results. For a free consultation, call the Columbia medical malpractice lawyers at Louthian Law Firm today at 1-803-454-1200, or fill out our confidential online consultation form.