domingo, 8 de agosto de 2010

Are you using checklists? Check! - JAAPA



CHECKLISTS SAVE LIVES


The Safe Surgery Saves Lives program selected eight global locations to test its 19-item surgical checklist (Jordan, India, Tanzania, Phillipines, Canada, England, New Zealand, and the United States). The sites were chosen to represent a broad range of geographic and socio-demographic attributes. Baseline data was collected prior to implementation of the checklist program. Hospitals were then asked to integrate the checklist into practice—it was translated into the appropriate language and adjusted to fit the individual institution's flow of care.


The study enrolled more than 3,700 patients for the baseline study and nearly 4,000 patients after introduction of the checklist. Results from the study showed statistically significant reductions in all measured events. The occurrence of any complication was reduced from 11.0% at baseline to 7.0% after checklist implementation, deaths decreased from 1.5% to 0.8%, surgical-site infections decreased from 6.2% to 3.4%, and unplanned returns to the operating room were reduced from 2.4% to 1.8%. Although the results varied by site, especially with respect to income levels, all sites showed improvement.6


The Keystone ICU project recruited 103 ICUs, of which 55 contributed both baseline and intervention data. Catheter-related bloodstream infections were reduced from 2.7 infections per 1,000 catheter days at baseline to no infections at 3, 6, 9, 12, 15, and 18 months after implementation of the checklist. Teaching hospitals had slightly higher rates during the first 9 months of follow-up; afterwards, incidence at these facilities was lowered to none as well. A small incidence of infections continued; however, it was nearly half of the preintervention rate. In this one study, the checklist saved an estimated 1,500 lives and nearly $200 million. The program itself cost only $500,000.9 An AHRQ-funded initiative is now expanding the use of the ICU checklist to all hospitals nationwide.


LIMITATIONS OF CHECKLISTS


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Are you using checklists? Check! - JAAPA

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