Study: Surgery Checklist Works, but Benefits Vary



A surgical checklist, similar to what pilots use before every flight, can lower patient death rates -- though the drop was smaller than past research has found, a Netherlands study said.

The study, conducted at one hospital and published in the Annals of Surgery, found that the results depend on surgical teams actually completing the checklist.


About 100,000 hospitals worldwide now use the surgical safety checklist developed by the World Health Organization (WHO). The list has 19 items that surgical teams check right before and after a patient's procedure, including making sure they have the right patient and are operating on the right side of the patient's body.

A 2009 study of eight hospitals in different countries found that in the year after the centers adopted the checklist, the overall death rate among surgery patients dropped from 1.5 percent to 0.8 percent.

But researchers at University Medical Center Utrecht, in the Netherlands, found a significantly smaller effect at their hospital, with the death rate of surgery patients dipping from 3.1 percent to 2.8 percent in the year-and-a-half after the hospital began using the checklist.

"Checklist compliance was clearly far from perfect in our hospital," wrote Wilton van Klein and his colleagues.

"Mortality was strongly associated with checklist compliance, suggesting that large variations in the level of implementation for different groups of patients need to be reduced."

One reason for the difference was that more critical patients needing emergency surgery were less likely to have a completed checklist, the researchers said.

Another may be that the center where van Klein and his team works is a university hospital that tends to get more critically ill patients than a community hospital would, The overall death rate among surgery patients there was higher than the average seen in the 2009 study, which included a mix of university and community medical centers.

It's estimated that medical errors occur in about one in 75,000 surgeries in the United States every year.

But surgical checklists alone are unlikely to be enough without an overall focus on the "safety culture" at hospitals, van Klein's team wrote.

Some of the biggest problems in hospitals aren't involved with surgery at all but concern infections, medication errors and injuries to patients who fall, according to the WHO.