Surgical Safety Checklists
Surgical Safety Checklists
Two recent publications describing surgical checklists provide proof of concept and move surgical checklists from 'a good idea' to 'standard of care'. A study from the Netherlands described the use of a series of checklists for the patient journey from admission to discharge (the Surgical Patient Safety System, SURPASS). This was a before and after study in six participating hospitals, and the results were strikingly similar to the SSSL pilot study; the proportion of patients with one or more complications decreased from 15.4% to 10.6% (P< 0.001), and in-hospital mortality decreased from 1.5% [95% confidence interval (CI), 1.2–2.0] to 0.8% (95% CI, 0.6–1.1). Importantly, there were five control hospitals, and outcomes did not change in the control hospitals over the same time period.
Neily and colleagues described the teamwork training and introduction of briefings and de-briefings in the operating theatre and the use of a surgical checklist in 108 Veteran Health Administration Hospitals in the USA. This quality improvement programme included 2 months of preparation, 1 day training for theatre teams, and 3 monthly coaching interviews for the implementation team over the following year. More than 180 000 procedures were analysed—there was an 18% reduction in annual mortality and 15% reduction in morbidity, significantly greater than in hospitals where training had not yet been delivered. A 'dose–response' relationship was noted for the training programme—for every 3 months of the training programme, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2–1.0; P= 0.001).
Other Surgical Checklists
Two recent publications describing surgical checklists provide proof of concept and move surgical checklists from 'a good idea' to 'standard of care'. A study from the Netherlands described the use of a series of checklists for the patient journey from admission to discharge (the Surgical Patient Safety System, SURPASS). This was a before and after study in six participating hospitals, and the results were strikingly similar to the SSSL pilot study; the proportion of patients with one or more complications decreased from 15.4% to 10.6% (P< 0.001), and in-hospital mortality decreased from 1.5% [95% confidence interval (CI), 1.2–2.0] to 0.8% (95% CI, 0.6–1.1). Importantly, there were five control hospitals, and outcomes did not change in the control hospitals over the same time period.
Neily and colleagues described the teamwork training and introduction of briefings and de-briefings in the operating theatre and the use of a surgical checklist in 108 Veteran Health Administration Hospitals in the USA. This quality improvement programme included 2 months of preparation, 1 day training for theatre teams, and 3 monthly coaching interviews for the implementation team over the following year. More than 180 000 procedures were analysed—there was an 18% reduction in annual mortality and 15% reduction in morbidity, significantly greater than in hospitals where training had not yet been delivered. A 'dose–response' relationship was noted for the training programme—for every 3 months of the training programme, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2–1.0; P= 0.001).
