Studies: Surgeons could save lives, $20B by using
checklist
By Liz Szabo
Jan. 14, 2009
USA TODAY

SURGERIES & COMPLICATIONS
• 45 million: Number of hospital surgeries annually in the USA
• 1.5 million: Number of serious surgical complications each year
• 200,000: Number of surgery-related deaths
Source: Atul Gawande
 

Eight hospitals reduced the number of deaths from surgery by more than 40%
by using a checklist that helps doctors and nurses avoid errors, according to a
report released online today in the New England Journal of Medicine.

If all hospitals used the same checklist, they could save tens of thousands of
lives and $20 billion in medical costs each year, says author Atul Gawande, a
surgeon and associate professor at the Harvard School of Public Health.

ON THE WEB: Read the full 'New England Journal of Medicine' article
VIDEO: WHO shows how to use the checklist

The 19-point checklist has nothing to do with high technology, Gawande says.
Instead, it focuses on basic safety measures, such as ensuring that patients get
antibiotics to prevent infection and requiring that all members of the team
introduce themselves.

"An operation involves hundreds of steps with lots of team members," Gawande
says. "We're good at making sure we do most of these things most of the time,
but we're not good at doing all of them all of the time."
FIND MORE STORIES IN: Jordan | Ireland | Philippines | United Kingdom | World
Health Organization | New England Journal of Medicine | Harvard School of
Public Health | Researchers | Institute for Healthcare Improvement | Alex Haynes
| Atul Gawande

In his study, which was funded by the World Health Organization, hospitals
reduced their rate of death after surgery from 1.5% to 0.8%. They also trimmed
the number of complications from 11% to 7%.

The study shows that an operation's success depends far more on teamwork
and clear communication than the brilliance of individual doctors, says co-
author Alex Haynes, also of Harvard. And that's good news, he says, because it
means hospitals everywhere can improve.

BETTER LIFE: Shortage of general surgeons looming

Researchers modeled the checklist, which takes only two minutes to go
through, after ones used by the aviation industry, which has dramatically
reduced the number of crashes in recent years.

Gawande says the checklist may have saved one of his own patients.

Before an operation recently, Gawande told his team that the operation might
be longer, bloodier and more complicated than usual. An anesthesiologist
made sure to have an extra supply of blood on hand. If the team had had to call
on the hospital blood bank — and take time to get the right type — the patient
could have died, he says.

Safety organizations around the world have pledged to get hospitals on board.
Four countries — the United Kingdom, Ireland, Jordan and the Philippines —
already have plans to use the checklist in all operations.

It usually takes 17 years for medical advances to become standard practice,
says Joe McCannon, vice president of the Institute for Healthcare Improvement,
which works with 4,000 American hospitals on improving quality. He wants the
country to move much faster this time by having all U.S. hospitals try the
checklist by April 1.
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