Surgical Checklist Helps Lower Patient Death Rates, Study Shows

NEW YORK (Reuters Health) - A surgical checklist, similar to what pilots use before every flight, can lower patient death rates, a study at one hospital confirms -- though the drop was smaller than past research has found.

About 100,000 hospitals worldwide now use the surgical safety checklist developed by the World Health Organization (WHO).

The list has 19 items that the surgical team checks right before and after a patient's procedure. That includes making sure they have the right patient, that they're operating on the correct body site and are aware of the patient's allergies.

A 2009 study of eight hospitals in different countries found that in the year after the centers adopted the WHO checklist, the overall death rate among surgery patients dropped from 1.5 percent to 0.8 percent.

In the new study, researchers at University Medical Center Utrecht, in the Netherlands, found a significantly smaller effect at their hospital.

Surgery patients' death rate dipped from 3.1 percent to 2.8 percent in the year-and-a-half after the hospital took up the WHO checklist.

But a lot depended on surgical teams' actually completing the checklist, the researchers report in the Annals of Surgery.

Patients with fully completed checklists, they found, had about one-third of the death risk of those without checklists. But the lists were completed for only 39 percent of patients.

"Checklist compliance was clearly far from perfect in our hospital," write Dr. Wilton A. van Klein and his colleagues.

One reason for that was that more-critical patients needing emergency surgery were less likely to have a completed checklist. But that did not seem to explain the lower death risk among patients with fully completed checklists, according to the researchers.

"Mortality was strongly associated with checklist compliance," van Klein's team writes, "suggesting that large variations in the level of implementation for different groups of patients need to be reduced."

One possible reason for the smaller effects compared with the 2009 study is differences among hospitals, according to van Klein and his colleagues.

Their center is a university hospital that tends to get more critically ill patients than a community hospital would. And the overall death rate among surgery patients there was higher than the average seen in the 2009 study, which included a mix of university and community centers.

The current findings are more in line with a recent study of U.S. Veterans Health Administration (VHA) hospitals, van Klein's team writes.

The VHA, which is the largest integrated health system in the U.S., has taken steps to cut medical errors -- which includes checklists and special training sessions to stress teamwork among staff.

A study earlier this year found that the number of medical errors at VHA hospitals -- like operating on the wrong patient, or the wrong side of a patient's body -- dropped from 3.2 to 2.4 per month, between 2006 and 2009.

It's estimated that across the U.S., medical errors occur in about one in 75,000 surgeries every year.

And surgical checklists alone are unlikely to be enough without an overall focus on the "safety culture" at hospitals, van Klein's team writes.

What's more, safety is an issue not only around the time of surgery. Some of the biggest problems in hospitals are infections, medication errors and injuries to patients who fall, according to WHO.

SOURCE: http://bit.ly/uoA69F Annals of Surgery, online November 24, 2011.