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.