NCPA - National Center for Policy Analysis


January 16, 2009

A new study found that after 8 hospitals adopted a 19-item checklist, the average patient death rate fell more than 40 percent and the rate of complications fell about a third, says the New England Journal of Medicine (NEJM). 

The researchers reviewed the outcome of 7,688 patients who were undergoing noncardiac surgery at the hospitals:

  • About half the patients had surgery before the checklists were adopted and half after.
  • At the end of the study, the average death rate dropped to 0.8 percent from 1.5 percent, and the average complication rate fell to 7 percent from 11 percent.
  • Some of the hospitals in the study have already begun using the checklist regularly.

However, it is hard to identify which items on the checklist had proved the most important.  But even a small change, say the researchers, like having surgical team members introduce themselves can have important consequences should one of them develop a concern during the operation.

Other items on the checklist are of more obvious importance, say the researchers:

  • The team must confirm the identity of the patient, the nature of the procedure, that all equipment has been sterilized and is present and that the patient has been given antibiotics to reduce the chance of infection.
  • Team members should verify that there is enough blood on hand if there is a risk of blood loss, that equipment measuring blood oxygenation is working and that all the medical images needed are present.
  • Afterwards, the doctors and nurses are supposed to review what has been done, discuss any special steps that need to be taken and confirming that no equipment was left in the patient.

The improvements in outcome, the researchers say, most likely came because of a combination of factors.  Beyond that, the changes in procedure may have brought about a broader change in behavior that improved safety, according to the researchers. 

Source: Eric Nagourney, "Simple Checklist Makes Surgery Safer," New York Times, January 20, 2009; Alex B. Hayes et al., A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population," New England Journal of Medicine, January 14, 2009.

For Times text:

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