Surgery deaths drop dramatically with checklist: study

A simple checklist, similar to the one pilots use before takeoff, helped to halve the rate of surgery-related deaths, an international team of doctors reported Wednesday.

The 19-step checklist developed by experts working with the World Health Organization included:

• Giving antibiotics on time.
• Making sure the correct patient is on the operating table, and the correct surgical site is identified.
• Checking anesthesia, blood supply and allergies.
• Counting needles and sponges to make sure nothing was left inside.

In this week's New England Journal of Medicine, researchers reported on how well the checklist worked on more than 7,500 surgical patients in eight hospitals, in Toronto, Seattle, London, New Delhi, Auckland, Manila, Amman in Jordan, and Ifakara in Tanzania.

The rate of death was 1.5 per cent before the checklist was introduced, and dropped to 0.8 per cent afterward, Dr. Atul Gawande of Harvard Medical School in Boston and his co-authors reported.

In-patient complications also dropped from 11 per cent to seven per cent.

The most significant drops were in complications such as infections, heart attacks and blood clots, said Dr. Bryce Taylor, surgeon-in-chief at Toronto's University Health Network, who led the study in Canada.

"If you look at two million operations, it adds up to 60,000 patients per year who would be spared having a complication after surgery," said Taylor. "That's a pretty provocative number."

The checklist is now used at the three hospitals that are part of Toronto's University Health Network: Toronto General Hospital, Princess Margaret Hospital and Toronto Western Hospital.

Checks done as a team

Phil Hassen, head of the Canadian Patient and Safety Institute in Montreal, said he hopes the checklist will become standard operating practice at every hospital in Canada within six months, given the dramatic improvements researchers have seen.

"It's cost-saving to the hospital but it's also beneficial to the patient — which is really a win-win, right?"

Previously, the members of a surgical team prepared for a surgery individually, but during the study, the checks on the list were done collectively, Taylor said.

"If you said 'Well, why didn't you do this before?' most surgeons would say, 'Well, I didn't need to do that, because I knew my patients. I knew that … they were allergic to such and such and I knew that they needed prophylaxis for their clotting, etc., etc.,"' he said.

"But what they didn't do was to go through it with the whole team, and it's amazing how many times you find out there's something. 'Oh, the blood isn't ready yet,' or 'The patient's allergic to latex' … and we've forgotten about that."

Taylor hopes going through the checklist will become as routine for operating room staff as putting on a seat belt has become for most Canadian vehicle passengers.