Simple Surgical Checklist Cuts Deaths by 40 Percent

What do flying an airplane and performing surgery have in common? Both can be safer by using a simple checklist. Just like airplane crews, medical teams going through a safety checklist before and after major operations can drastically reduce deaths and complications, a study led by Harvard researchers shows.

A two-minute checklist confirming safe delivery of anesthesia, prophylaxis against infection, and other basic safety items reduced complications and deaths after surgery by one third in eight hospitals around the world. “The checklist reduced complications by double digits in every hospital we put it in,” said senior author Atul Gawande, HMS associate professor of surgery at Brigham and Women’s Hospital and HSPH associate professor in the Department of Health Policy and Management. Overall, the rate of complications went down from 11.0 percent to 7.0 percent while the inpatient death rate fell by more than 40 percent.

Gawande’s team screened complications and death rates after surgery in hospitals from the United States, Canada, England, New Zealand, Jordan, India, Tanzania, and the Philippines. A total of 7,688 patients were analyzed: 3,733 before the 19-item checklist was introduced and 3,955 afterwards. The study was part of the World Health Organization Safe Surgery Saves Lives campaign and was published online Jan. 14 in The New England Journal of Medicine.

With 234 million operations performed worldwide every year, universal use of the checklist could save hundreds of thousands of lives, said Gawande. He has used the checklist for almost a year at BWH. In one case, the procedure saved the life of a patient by reminding the team to have enough blood ready for a transfusion. The checklist also includes oral verification of the patient’s identity, the site and type of operation, appropriate antibiotic use, and a quick review of the names and roles of surgical team members.

“This simple, inexpensive, team-based intervention has a dramatic impact on the quality of patient care,” said lead author Alex Haynes, a research fellow at HSPH. The checklist could also be extremely cost-effective in the United States. Implementing the procedure has minimal capital costs, and it could save up to $25 billion in complication-related expenses annually, said Haynes.

Although safety checklists have been used in aviation and other fields for decades, they are new to surgery. “Our goal is to bring surgical teams around the world to give it a try and make it part of their practice,” said Gawande. The United Kingdom, Ireland, Jordan, and the Philippines have already started nationwide plans to implement the checklist in all operating rooms. In the U.S., State Hospital Associations in Washington, North Carolina, South Carolina, and New York have also committed to using it.

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Conflict Disclosure: The authors report no conflicts of interest.

Funding Sources: WHO