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SC study: Surgical checklists help patients avoid deadly complications

Dr. Matthew C. Indeck finishes an operation Monday at Providence Hospital. The hospital uses a surgical safety checklist, which a study says helps reduce deadly complications after surgery.
Dr. Matthew C. Indeck finishes an operation Monday at Providence Hospital. The hospital uses a surgical safety checklist, which a study says helps reduce deadly complications after surgery. online@thestate.com

A surgical checklist for doctors and other operating room workers appears to help patients avoid deadly complications after surgeries, according to a study of South Carolina hospitals released Monday.

The checklist, created by the World Health Organization, prompts medical teams to discuss the surgical plan, risks and concerns. Use of the checklist apparently helped reduce post-operative deaths from infections, hemorrhages and organ failures.

The 19-item checklist empowers each member of a surgical team to monitor others during ever more complex surgeries. By talking about the steps, a culture of operating room communication is created, said June Duggan, director of anesthesia and perioperative services at Lexington Medical Center.

Some items on the checklist include confirming the patient's identity before induction of anesthesia, marking the site of surgery, confirming any allergies, confirming team members for name and role, and after surgery confirming instrument counts, name of procedure and specimen labeling, according to UPI.

“It’s a double-check,” said Duggan, who compared the complexity of the modern operating room to the cockpit of an airplane. “As we become more complex, we can become more and more fragmented. With the checklist, everyone stands up speaks their name and speaks their part. It empowers people to speak their point of view.”

The five-year project involved the South Carolina Hospital Association, Ariadne Labs and Harvard University’s T.H. Chan School of Public Health. The findings will appear in the August print issue of the Annals of Surgery as well as online.

The study is the first to demonstrate the large-scale impact of the World Health Organization’s Surgical Safety Checklist, according to the news release.

Nearly every hospital in South Carolina adopted the checklist after the study began in 2010, said Schipp Ames, spokesman for the hospital association, in a program called Safe Surgery South Carolina.

Ultimately, data from 14 hospitals were chosen for the study. Those 14 were the most advanced in implementing the checklist when the study period ended in December 2013. Those hospitals represent nearly 40 percent of inpatient surgeries in South Carolina.

Researchers compared the 30-day post-surgery mortality outcomes of those hospitals with the mortality outcomes of the rest of the hospitals in the state. Surgical procedures in the analysis represent a wide range of specialties, from neurological, thoracic and cardiac, to soft tissue and orthopedic.

The names of the 14 hospitals were not revealed by researchers, Ames said. “They wanted a blind study. They didn’t want it to turn into winners and losers.”

The study found that the post-surgery death rate in the 14 hospitals fell from 3.38 percent in 2010 — before the checklist was used — to 2.84 percent in 2013. In the other 44 hospitals, mortality rose from 3.5 percent in 2010 to 3.71 percent in 2013. This corresponded to a 22 percent difference in mortality between the groups, according to a news release from the hospital association, Ariadne Labs and the Harvard public health school.

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