Simple Checklist Reduces Deaths By a Third

Sometimes the best innovations are simple. This has certainly been the case in Scotland, where a 19-item checklist has decreased post-surgical deaths by 36%.

Globally each year, 4.2 million people die of Perioperative Mortality (any death that occurs 30 days after surgery). Common complications include:

• Infection
• Blood clots
• Pulmonary
• Neurologic
• Liver and kidneys
• Fever

Many of these complications are the result of human error. To cut down on this, public health researcher and American surgeon Atul Gawande created a 19-item checklist for doctors and nurses to review over the course of three stages of surgery. The questions are extremely simple but potentially life-or-death in consequence, ranging from whether the patient has any known allergies to confirming the patient’s name and the scheduled procedure before a doctor makes the first incision.

Following its creation in 2008, the World Health Organisation introduced the Surgical Safety Checklist to its catalogue of resources. As use of the Checklist has become more widespread, specific implementation factors have become more apparent and today it’s used in many different ways. Factors for successful implementation include:

• Early engagement of staff
• Active leadership and identification of local champions
• Extensive discussion, education and training
• Multidisciplinary involvement
• Coaching
• Ongoing feedback
• Local adaptation

Impact in Scotland

The findings out of Scotland are based on an analysis of 6.8 million operations performed between 2000 and 2014, with rates falling to 0.46 deaths per 100 procedures over this period. The fall in death rates was seen only in patients who had surgery.

NHS Grampian surgeon and National Clinical Lead for the Scottish Mortality and Morbidity Review Programme Dr Manoj Kumar said:

“This study reaffirms the importance of the WHO Surgical Safety Checklist which functions as a key aide in promoting effective team-working, communication and other relevant non-technical skills in surgery which is critical in ensuring good outcomes.”

Scotland’s National Clinical Director Professor Jason Leitch said:

“This is a significant study which highlights the reduction in surgical mortality over the last decade. While there are a number of factors that have contributed to this, it is clear from the research that the introduction of the WHO Surgical Safety Checklist in 2008 has played a key role.”

Click here to learn more about the Scottish Patient Safety Programme.