Surgical Checklists Improve Safety, Reduce Risk of Death: Study

Hospitals that implemented a World Health Organization (WHO) approved surgical checklist reduced the rate of patient deaths during the month following surgery, according to the findings of new research. 

In a study this week in the medical journal The BMJ, researchers compared the death rates 30 days after surgery at South Carolina hospitals, and found that facilities that used the WHO Surgical Safety Checklist were able to reduce death rates by 22%, compared to hospitals that did not use the checklist.

A total of 14 hospitals in South Carolina participated in a voluntary statewide 12-step program to implement the WHO Surgical Safety Checklist. Those hospitals represent 40% of the total inpatient surgery population in the state.

The 30-day post-surgery mortality rates of the 14 hospitals were compared to the remaining hospitals in the state that did not implement the safety checklists. The hospitals represented major inpatient surgical procedures including neurological, cardiac, and orthopedic specialties.

Researchers indicate that the death rates in 2010, before hospitals implemented the checklists, were 3.8%. That decreased to 2.84% in 2013, after the checklists were implemented.

Among hospitals that did not implement the checklists, their death rate was 3.5% in 2010, increasing to 3.71% in 2013. Overall, implementing the checklists resulted in a 22% reduction of deaths 30 days after surgery in the hospitals that completed the program.

The WHO checklist includes certain requirements designed to reduce the risk of surgical mistakes, such as making sure the medical team confirms the patient’s identity, confirms the procedure to be done, and confirms the surgical site before the procedure. It also calls for counts to be taken for medical instrument and sponges, discussing the procedure with the patient, discussing patient allergies and calling for a final conversation between the surgeon, anesthetist and nurse about the recovery and management plan.

Researchers said the checklist is a tool designed to help change the surgical room practices of the team, and create an environment of communication, where healthcare professionals are encouraged to speak up and share information.

Prior studies have had mixed results concerning the effectiveness of surgical checklists. A 2014 study indicated the use of surgical checklists failed to improve outcomes. Risk of death after surgery and surgical complications did not improve after checklists were implemented. However, another study published in 2013 indicated complications from robotic surgery were reduced after surgical safety checklists were implemented.

Researchers said there were limitations to the newest study, which make the findings less conclusive. This was not a controlled study. Instead, it was done as a quality improvement initiative, not a research project. It also did not account for other differences in the hospital that may have attributed to the mortality rates.