Surgical checklist 'saves lives'

Experts are concerned that complication rates are too high

Using a simple surgical checklist during major operations can cut deaths by more than 40% and complications by more than a third, research has shown.

The National Patient Safety Agency (NPSA) has ordered all hospitals in England and Wales to use it across the board by February 2010.

The checklist, devised by the World Health Organization (WHO), was tested in eight cities around the globe.

The year-long study features online in the New England Journal of Medicine.

Dr Atul Gawande, of Harvard School of Public Health, explains the checks

The checklist is made up of a single page that requires only a few minutes to complete.

It focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent problems such as infection and unnecessary blood loss.

It was tested in hospitals in Seattle, Toronto, London, Auckland, Amman, New Delhi, Manila and Ifakara, Tanzania.

In total data was collected from 7,688 patients, 3,733 before the checklist was implemented, and 3,955 afterwards.

The rate of major complications fell from 11% to 7%, and the rate of inpatient deaths following surgery fell more than 40% from 1.5% to 0.8%.

'Startling results'

The cut in deaths and complications was similar across all the hospitals in the study.

FOLLOW THE PROCEDURES Surgical Safety Checklist [765KB] Most computers will open this document automatically, but you may need Adobe Reader Download the reader here

Researcher Dr Atul Gawande, from Harvard School of Public Health, said the checklist could become as essential in daily medicine as the stethoscope.

He said: "The results are startling.

"They indicate that gaps in teamwork and safety practices in surgery are substantial in countries both rich and poor.

"With the annual global volume of surgery now exceeding even the volume of childbirth, the use of the WHO checklist could reduce deaths and disabilities by millions.

"There should be no time wasted in introducing these checklists to help surgical teams do their best work to save lives."

Dr Alex Haynes, who led the study, said the checklist had a significant impact at every hospital site in the study.

"Even many clinicians who were initially sceptical of the idea became advocates once they saw the benefits to safety and consistency of care."

Professor David Taube, medical director at Imperial College Healthcare NHS Trust, which piloted the checklist, said: "The results speak for themselves and show that use of the checklist can make a significant difference."

Dramatic improvement

Dr Kevin Cleary, NPSA medical director, said: "The results of the study give clear evidence that a simple intervention leads to dramatic improvement in outcome for patients undergoing surgery."

In the UK patients undergo more than eight million surgical procedures every year.

The beauty of the surgical safety checklist is its simplicity Health Minister Lord Darzi

In 2007, 129,419 surgical incidents were reported to the NPSA. Over 1,000 resulted in severe harm and 271 led to the death of the patient.

Dr Cleary said: "The pilot study has shown we can do much better."

Health Minister Lord Darzi, who played a role in developing the checklist, said: "The beauty of the surgical safety checklist is its simplicity and - as a practising surgeon - I would urge surgical teams across the country to use it.

"Operating theatres are high-risk environments. By using the checklist for every operation we are improving team communication, saving lives and helping ensure the highest standard of care for our patients.

"The amazing results from the global pilot puts this beyond any doubt."

'Days - not months'

But Katherine Murphy of the Patients Association criticised the delay in bringing the checklist in.

"Patients who are going into hospital for an operation today, tomorrow and everyday until February 2010 should not be left wondering whether the basic safety questions are going to be asked before their operation starts.

"The NPSA should ensure that this checklist is used for every operation within days not months."

In Scotland, the use of checklists is already part of a drive to cut adverse events following surgery by 30%, and deaths following surgery by 15% by 2011.