Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Do surgery checklists really work?

Skeptical Scalpel, MD
Physician
January 12, 2017
47 Shares
Share
Tweet
Share

A before and after study at the University of Vermont Medical Center found that a 24-item operating room checklist did not significantly reduce the incidence of any of nine postoperative adverse outcomes.

More than 12,000 cases were studied, and outcomes included: mortality, death among surgical inpatients with serious treatable complications, sepsis, respiratory failure, wound dehiscence, postoperative venous thromboembolic events (VTE), postoperative hemorrhage or hematoma, transfusion reaction and retained foreign body (FB).

After the checklist was established, respiratory failure rates decreased significantly on the initial analysis, but the difference disappeared when the Bonferroni correction* was applied to the dataset.

Why didn’t the checklist work? I have discussed this in previous blog posts here and here. As was true in previous papers of this nature, many of the complications studied — respiratory failure, wound dehiscence, transfusion reaction, postoperative hemorrhage or hematoma — could not have been prevented by a checklist.

The hospital probably had a reasonable VTE prophylaxis protocol before the checklist was adopted in 2012 making it unlikely to have had much of an impact on that problem. Similarly, measures to prevent retained FBs existed well before the OR checklist was invented, and retained FBs occur too infrequently to have resulted in a meaningful difference in this setting.

Another possible explanation for the lack of efficacy of the checklist is that in a university teaching hospital in the United States, most preventable adverse outcomes were already occurring at a low rate.

As part of the study, a survey of operating room personnel including surgeons, anesthesiologists, and nurses found most of the staff understood why the checklist was used and felt it improved patient safety and communication and decreased errors.

The study did not look at either the compliance with checklist use or completeness of the documents. However, the survey revealed that the staff disagreed about the level of completeness of the checklist. About 70 percent of nurses and anesthesiologists believe that the checklist process was rushed compared with only 42% of surgeons. (Rushed? Not us!)

Over 80% of those who completed the survey said they would like to have a checklist used if they were to undergo surgery.

My view of checklists is that they may not prevent complications, but the minute or two spent on going over them is probably worth the effort.

For example, I know a surgeon who found out in the middle of an operation that the type of mesh he wanted to use for a hernia repair was not available. Attention to the checklist would have allowed him to cancel the case or plan from the start to use another product.

So go ahead with your OR checklist, but don’t be surprised if it doesn’t prevent complications.

*An adjustment made to p values when several dependent or independent statistical tests are being performed simultaneously on a single data set.

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.  

Image credit: Shutterstock.com

Prev

Is it a stroke or a secret?

January 12, 2017 Kevin 1
…
Next

There is a direct connection between inefficiency and burnout

January 12, 2017 Kevin 8
…

Tagged as: Surgery

Post navigation

< Previous Post
Is it a stroke or a secret?
Next Post >
There is a direct connection between inefficiency and burnout

More by Skeptical Scalpel, MD

  • The hospital CEO who made a surgical incision. What happened?

    Skeptical Scalpel, MD
  • Medical error is not the third leading cause of death

    Skeptical Scalpel, MD
  • Should speed-eating contests be banned?

    Skeptical Scalpel, MD

Related Posts

  • Please change the culture of surgery

    Anonymous
  • Why cataract surgery is more complicated than it should be

    Brian C. Joondeph, MD
  • Robotic surgery’s impact on training the next generation of surgeons

    Barry Greene, MD
  • Women in surgery: a tweet to action

    Sarah Shubeck, MD and Arielle Kanters, MD
  • Americans and Canadians use more post-surgery opioid pain pills

    Julie Appleby
  • A physician’s addiction to social media

    Amanda Xi, MD

More in Physician

  • Discover the power of patience

    Diane W. Shannon, MD, MPH
  • Doctors rediscover joy in practicing medicine, on their own terms

    Kim Downey, PT
  • Physician return-to-work policies

    Deepak Gupta, MD
  • How my patients’ Zoom backgrounds made me a better doctor

    Joseph Barrera, MD
  • Understanding reproductive rights: complex considerations

    Anonymous
  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Sexual Activity Lowers Risk of Side Effects After Cervical Cancer Treatment
  • Preoperative Algorithm Might Halve Unnecessary Oophorectomies in Children
  • California Misinfo Law Is Dead
  • CDC's Turtle Warning; Largest Healthcare Worker Strike? Docs' Political Landmines
  • Addressing Root Causes: A Call to Tackle the Black Maternal Health Crisis

Meeting Coverage

  • Sexual Activity Lowers Risk of Side Effects After Cervical Cancer Treatment
  • Hot Flashes: Precursor to Alzheimer's Disease?
  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief
  • Study Pinpoints Growing Use of Cannabis to Manage Menopause Symptoms
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Do surgery checklists really work?
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...