20 Nov 10
By J Birkmeyer
N Engl J Med 2010; 363:1963-1965
Long standard in the safety-conscious aviation industry, checklists are now being promoted aggressively in the medical literature and popular press. Almost all U.S. hospitals mandate simple preoperative “time-outs” to minimize the risk of egregious mistakes, such as operating on the wrong site or the wrong patient. Recently, however, many hospitals have started implementing more comprehensive checklist procedures for the operating room, aimed at increasing compliance with practices known to reduce complications and enhancing teamwork. Last year, a large international study supported by the World Health Organization (WHO) reported that such checklists cut surgical morbidity and mortality almost in half.
19 Nov 10
By E de Vries, H Prins, R Crolla, A den Outer, G van Andel, S van Helden, W Schlack, A van Putten et al for the SURPASS Collaborative Group
NEJM 2010; 363:1928-1937
Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway.
We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals.
In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals.
Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care.
13 Jun 09
By R J Glavin
Anesthesiology 2009; 110:201–3
All truths are easy to understand once they are discovered; the point is to discover them. — Galileo Galilei
I invent nothing, I rediscover. — Auguste Rodin
THIS is the second editorial of four looking at excellence in anesthesiology. In the introductory editorial, Smith set the scene by encouraging us to look beyond the more conventional and obvious areas of the curriculum, such as knowledge of applied physiology or performance of regional anesthetic techniques, and to explore those areas that are less well defined but of equal importance for the complexity of our tasks as clinical anesthesiologists. The theme that is common to this series of editorials is that the different components of excellence are already present in the practice of anesthesiology and always have been, as Rodin observed in the quote above. Although present, these components are tacit and not explicit.
12 Jun 09
By A Smith
Anesthesiology 2009; 110:4–5
WE owe it to our patients, our colleagues, and ourselves to strive for excellence in all that we do. Safe, highquality patient care, good working relationships, and our own professional pride and fulfillment are all at stake. Nevertheless, for all its importance, attempts to explore the many facets of excellence in anesthesiology have been made only recently. This editorial is the first in a series of four in which international anesthesiologists who have recently published on excellence and professionalism in our specialty will outline some of the methods available for the understanding and promotion of excellence.