The Effect Of Creating And Using A Safety Checklist

In Conjunction With The Performance Of Non-Cardiac Surgery

In January of 2009 the New England Journal of Medicine published the results of a study conducted by the Harvard School of Public Health at the Massachusetts General Hospital in Boston reporting the effect of creating and using a safety checklist in conjunction with the performance of non-cardiac surgery. Eight hospitals in eight cities as diverse as New Deli, India and Seattle, Washington participated in this study.

All hospitals who participated in this study employed a surgical safety checklist. Remarkably, none of the items involved new technology or surgical techniques.

The checklist items were as follows:

1. Requiring each surgical patient to verify his or her own identity, surgical site and procedure.
2. Marking the surgical site.
3. Using pulse oximetry.
4. Requiring that surgical team members pause to introduce themselves by name and role and then reviewing anticipated critical events.
5. Confirming that prophylactic antibiotics were administered greater than sixty minutes before incision.
6. Confirming needle and sponge counts and at completion of the surgery revealing key concerns for the patient’s recovery and care.

The implementation of the checklist items with respect to the non-cardiac surgical patients greater than 16 years of age resulted in a reduction in complications associated with the surgery from 10.3% to 7.1% and at high income study sites such as Seattle, Toronto, London, etc. the death rate diminished from .9% to .6%.

When one considers that 234 million operations are performed globally each year, a universal adoption of the checklist could result in saving as many as 702,000 persons annually worldwide.

Even more important, perhaps is the near 40% reduction in postoperative complications after introduction of the checklist. The checklist represents a potential for preventing postoperative complications worldwide annually by 9,360,000.

It is perhaps not so surprising that safe surgery requires an attention to very simple details which assure that all members of the team know what they are about.

Regrettably, there is no agency or law which compels our hospitals and healthcare providers to implement a surgical checklist. Indeed, the only tool available to families of patients harmed by medical negligence generally is the medical malpractice lawyer.

In Pennsylvania and many other states lawyers have fought to maintain the right of victims of medical negligence to seek justice in our courts. No doctor or other healthcare provider, hospital or otherwise is above the law.

The civil justice system provides an important incentive to healthcare professionals. There is no other effective mechanism for holding them accountable and assuring that those victims of medical negligence obtain the compensation they deserve to help them meet the great economic and other challenges which they face.