The next big break through in surgery might not be a sophisticated new tool or imaging device; instead, it may be a simple checklist that the surgical team has to run through before making the first incision. In a pilot study, researchers found that using the checklist cut the death rate following surgery by 47 percent, while the complication rate decreased by 36 percent. The procedure is simple: Surgeons and nurses run through a series of basic safety checks before each operation, similar to those made by pilots before take-off. The checks include asking: Is this the right patient? Is this the right limb? Has the patient had the right drugs? [The Independent]
The checklist is composed of 19 fairly obvious items, but lead researcher Atul Gawande says that even a small change, like having surgical team members take a moment to say who they are and what they do before scalpel touches skin, can have important consequences later on should one of them develop a concern during the operation. Earlier studies have shown that communication problems are fairly common in operating rooms, with junior members of the team sometimes hesitant to speak up. “Giving them a chance to say their names allows them to speak up later,” Dr. Gawande said [The New York Times].
The pilot study was an initiative of the World Health Organization. The research team tested their simple idea with often dubious and unhappy surgical teams operating on more than 7,500 surgical patients in eight hospitals in Toronto, Seattle, London, New Delhi, Amman, Auckland, Manila and Ifakara in Tanzania [Reuters]. Interestingly, the hospitals in both developed and developing world countries saw about the same reduction in post-surgical complications. Based on the checklist’s unambiguous benefits, which were reported in the New England Journal of Medicine, Britain’s health agency announced that all surgeons in England and Wales must start using the checklist by February 2010.
Some surgeons may resist integrating the checklist into their routine, says Peter Walsh, of the medical watchdog group Action against Medical Accidents. “Some surgeons say that checklists de-professionalise them, turning them into automatons who don’t think” [The Independent], he says. Other surgeons argue that they already ask all the questions listed on the checklist, and don’t need a piece of paper to remind them how to do their jobs. But the research team maintains that the checklist ensures consistency in surgical procedures, and also promotes teamwork and communication. Those simple factors can save a lot of lives and prevent a lot of pain, says Donald Berwick, the president of the US Institute for Healthcare Improvement. “I cannot recall a clinical care innovation in the past 30 years that has shown results of the magnitude demonstrated by the surgical checklist” [The Independent], he says.
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