Operating Room Deaths Decreased by Checklists: Study

European researchers say that the use of extensive hospital checklists could result in a 31 percent decline in patient complications from surgical mistakes. 

A study published last month in the New England Journal of Medicine adds to a growing body of evidence that suggests the simple use of a checklist in the operating room and elsewhere can reduce the chances of incidents such as wrong-site surgeries or operating tools being left inside of patients’ bodies.

Experts consider wrong-site and wrong-patient surgery mistakes as “never” events, which should not happen if the surgeon and medical staff follow the appropriate standards of medical care.

Researchers looked at nearly 4,000 patients at 11 hospitals in The Netherlands over a 3-month period and found that when medical staff used extensive checklists that cover pre-surgery, surgery, and post-operative procedures, the number of complications dropped from 27.3 per 100 patients to 16.7. That represents a reduction of nearly one-third. Overall in-hospital mortality dropped from 1.5% to 0.8%, cutting mortality in half.

Previous checklists have been confined to procedures during surgery, but experts say that most complications are the result of errors that occur following the operation. The checklist used by the European researchers includes circling the proper operation site, performing an inventory of all medical tools and sponges before and after surgery and double-checking the patient’s post-surgery prescriptions.

In different study published last month in the Journal of the American Medical Association, researchers found that Veterans Health Administration medical teams who worked together and created a surgery checklist dramatically reduced mortality and medical mistakes in the operating room. When tactics such as pre-surgery briefings, teamwork and surgery checklists were employed at 74 VA hospitals over three years, surgery mortalities dropped 18 percent.

Researchers examined a program that was started at VA hospitals in 2003 and is in place in nearly all of its 130 surgical centers nationwide. Instead of the head physician dictating the entire surgery, the surgical team members create a checklist and have a team briefing before, during and after the surgery. The program also involves patients identifying themselves and what surgery they have been told is going to be performed before being sedated, and also get to hear the checklist being read off.