A simple tool can potentially yield huge beneficial results.
As reported by MedPage Today, Atul Gawande led a team that studied whether surgical teams who completed one-page procedural checklist in the operating room affected patient care.
The results, published in the NEJM, were stark. In eight hospitals in eight different countries, both 30-day death rates from non-cardiac surgery and inpatient complications were significantly lowered.
If the results could be validated, and the checklist widely implemented, this potentially can result in huge improvements in patient mortality and complications after surgery.
And that’s a big if, says surgeon Jeffrey Parks who casts a skeptical eye on the findings.
“Closer inspection of the data demonstrates that the biggest improvements were seen in hospitals from third world countries,” he writes. “This makes sense because in the United States, we’ve already been marking surgical sites and calling pre-op ‘time-outs’ for several years.”
So indeed, can a set of “irritating instructions on a laminated list,” really halve death rates?
The jury’s still out on that.
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{ 4 comments }
At one time, pilots thought they didn’t need a checklist to fly a plane, now the US is in 3rd year of no airline fatalities.
This article is also good reading. “Medicine today has entered its B-17 phase” http://is.gd/2svs
It’s startling to know that the folks in the OR introducing themselves to one another is an item.
Perhaps addressing one another as “hey you” isn’t conducive to productivity and safety.
It has been proven to work in other areas, and this isn’t the first study showing benefit in medicine. As a physician, I used to buy into the egocentric myth that doctors were different. Even Kings on a throne sit on their asses like everyone else.
Our brains are no different, we are prone to the same errors, and can use some of the same ideas to minimize them.
Several years ago I started using a simple checklist with outpatients. The same one I used mentally, but the mind slips at time, especially when distracted by curve balls and smoke and mirror acts. It helps.
I also fly. I memorize the checklists that I use perform the items and then check against the list for performance–often something was forgotten!
Checklists don’t work when people don’t take it seriously. They will tend to fake it, go through the motions. The last instrument in the belly case I saw, the instrument count was checked off. I have personally seen 220# surgeons rant and snort at trembling 22 year old nurses while they recheck the sponge the count which is incorrect. It is probably good that I was more of a coward when I was young because I don’t think I could watch that today with giving the bastard the ass kicking he deserved upon exiting the OR.
I looked at the ‘checklist’ from the article. At our hospital we do all but “introduce ourselves” and discuss “critical and unexpected steps”. That step could actually be a full hour of lecture and debate in my specialty for some cases (PV surgery) Do I need to create a sub checklist for every case type I do for that step?
I believe due to the actions of the Joint Commission, the vast majority of hospitals already do the majority of this “checklist” I think the gains seen in the study are from the international centers that do not have the pluses (and minuses) of TOFKAJACHO!
DocInKY
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