Checklists Reduce Surgery Deaths & Complications

NLM Director's Comments Transcript: Checklists Reduce Surgery Deaths & Complications 01/03/2011

Picture of Dr. Lindberg
Picture of Dr. Lindberg

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.listen

Comprehensive checklists cut post-surgery deaths in half and significantly reduce post-surgical complications, reports a study from Holland recently published in the New England Journal of Medicine.

In six participating Netherlands' hospitals, post-surgery complication rates fell by 31 per patient and death rates dropped to less than one percent (about half of the rate in control hospitals) after implementing a group of patient safety checklists. In contrast, post-surgery death rates at five control hospitals in Holland remained around 1.5 percent and complication rates were unchanged.

The proportion of patients with one or more post-surgical complication rates also comparatively declined significantly and there were significant, comparative reductions in the proportion of patients with a temporary disability and those who required a second surgery.

The study's intervention side compared surgical complications and death rates for about 3,700 patients three months before the implementation of a checklist – with the rates for 3,800 patients for a three-month period after six participating hospitals initiated the recommended procedures. The study's 12 authors (who are Dutch medical faculty and researchers) reported death and complication rates were the lowest among the participating hospitals that adhered more strictly to a checklist of surgery related, patient safety procedures.

The authors explain previous research about the impact of checklists on improving surgical patient safety focused on a checklist's impact within an operating room. In the Holland study, the checklist included operating room procedures but added what the authors describe as (and we quote) 'the entire surgical pathway' (end of quote), which encompassed 11 different components. The added components within the expanded checklists included: medication and discharge instructions to improve adherence when a patient leaves the hospital, and post-operative instructions for health care providers.

Checklists also were targeted for a variety of health care professionals including ward doctors, nurses, surgeons, anesthesiologists, and other health care staff who routinely see patients before, during, and after a surgery. Health care professionals were encouraged to go through a tailored checklist twice.

The authors write (and we quote): 'the checklist may lead to improved outcomes by improving teamwork, communication, and attitudes toward quality and safety' (end of quote).

The authors acknowledge the checklists used in the study require time and effort to implement. Similarly, they acknowledge health care providers in participating hospitals did not consistently adhere to all the checklists' recommendations.

However, the authors write (and we quote), 'by providing a blueprint of the ideal situation, the system reveals safety risks and triggers improvements in all stages of the surgical pathway' (end of quote).

The authors note the current study provides a more rigorous assessment of the potential of checklist use and hospital safety than previous research because the control hospitals retained a high standard of care for surgery patients. In other words, the study suggests improvements occur from comprehensive checklists even when these procedures are compared with medical centers with higher than normal surgical safety practices.

In an accompanying editorial, John Birkmeyer M.D., University of Michigan, notes the Dutch study does not assess what specific checklist items are optimal. However, Dr. Birkmeyer writes, and we quote: 'checklists seem to have crossed the threshold from good idea to standard of care' (end of quote).

MedlinePlus.gov's surgery health topic page provides comprehensive information to help patients and caregivers make decisions (and provide their own checklists) if a surgical procedure is recommended.

A helpful website from the Agency for Healthcare Research and Quality provides diverse, basic information about surgical procedures to consumers. This website is available in the 'start here' section of MedlinePlus.gov's surgery health topic page.

A video also from the Agency for Healthcare Research and Quality suggests some questions to ask health care providers before surgery. It is available within the 'videos' section of MedlinePlus.gov's surgery health topic page.

MedlinePlus.gov's surgery health topic page additionally provides the latest relevant journal articles, which are available in the 'journal articles' section. Some information about surgery is tailored for children, teens, and seniors – each within a separate section.

To find MedlinePlus.gov's surgery health topic page, type 'surgery' in the search box on MedlinePlus.gov's home page, then, click on 'Surgery (National Library of Medicine).'

MedlinePlus.gov also has home pages devoted to specific procedures, such heart surgery, organ transplantation, plus plastic and cosmetic surgery. Overall, we trust this information will add to the efforts represented by the Dutch study – and result in improvements in patient surgical safety.

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Checklists Reduce Surgery Deaths & Complications